Frequency of Atrial Septal Aneurysm in Patients With Cerebral Ischemic Events
To the Editor:
We read with great interest the article by Agmon et al,1 which was a transesophageal echocardiographic study comparing the frequency of atrial septal aneurysm (ASA) in patients with cerebral ischemic stroke with a large group from the general population. They found that the odds of ASA were 3.65 times greater (95% confidence interval, 1.64 to 8.13) in patients than in controls after adjustment for age and sex. The frequency of patent foramen ovale (PFO) in patients and controls with ASA was similar (≈56%); however, the frequency of PFO among patients and controls without ASA was not reported. Given that a large right-to-left shunt due to PFO is associated both with ASA and an increased risk of ischemic stroke,2 the authors should have given the odds of ASA adjusted for the presence of PFO. It is possible that ASA is only an anatomical defect associated with PFO and does not have a pathophysiological role of its own. This fact is important not only from an etiopathogenic point of view but also from a practical one. A noninvasive diagnostic procedure, such as transcranial Doppler, which cannot detect ASA but is highly accurate in the diagnosis of PFO, may be sufficient as a screening test in stroke patients.
- Copyright © 2000 by American Heart Association
Agmon Y, Khandheria BK, Meissner I, et al. Frequency of atrial septal aneurysm in patients with cerebral ischemic events. Circulation. 1999;99:1942–1944.
Serena J, Segura T, Perez-Ayuso MJ, et al. The need to quantify right-to-left shunt in acute ischemic stroke: a case-control study. Stroke. 1998;29:1322–1328.