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Title: Patent foramen ovale with atrial septal aneurysm is strongly associated with migraine with aura: a large observational study
Austin Authors: Snijder, Roel JR;Luermans, Justin GLM;de Heij, Albert H;Thijs, Vincent;Schonewille, Wouter J;Van De Bruaene, Alexander;Swaans, Martin J;Budts, Werner IHL;Post, Martijn C
Affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiology, University Health Network, Toronto, Canada
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Issue Date: 1-Dec-2016 2016-12-01
Publication information: Journal of the American Heart Association 2016; 5(12): e003771
Abstract: A patent foramen ovale (PFO) with atrial septal aneurysm (ASA) has been identified as a risk factor for cryptogenic stroke. Patients with migraine with aura (MA) appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between MA and PFO with ASA has never been reported. We examined this association in a large observational study. METHODS AND RESULTS: Patients (>18 years) who underwent an agitated saline transesophageal echocardiography (cTEE) at our outpatient clinics within a timeframe of 4 years were eligible to be included. Before cTEE they received a validated headache questionnaire. Two neurologists diagnosed migraine with or without aura according to the International Headache Criteria. A total of 889 patients (mean age 56.4±14.3 years, 41.7% women) were included. A PFO was present in 23.2%, an isolated ASA in 2.7%, and a PFO with ASA in 6.9%. The occurrence of migraine was 18.9%; the occurrence of MA was 8.1%. The prevalence of PFO with ASA was significantly higher in patients with MA compared to patients without migraine (18.1% vs 6.1%; OR 3.72, 95% CI 1.86-7.44, P<0.001). However, a PFO without ASA was not significantly associated with MA (OR 1.50, 95% CI 0.79-2.82, P=0.21). Interestingly, a PFO with ASA was strongly associated with MA (OR 2.71, 95% CI 1.23-5.95, P=0.01). CONCLUSION: In this large observational study, PFO with ASA was significantly associated with MA only. PFO closure studies should focus on this specific intra-atrial anomaly.
DOI: 10.1161/JAHA.116.003771
PubMed URL:
Type: Journal Article
Subjects: Atrial septal aneurysm
Cerebrovascular disorders
Heart septal defect
Patent foramen ovale
Appears in Collections:Journal articles

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