Patent Foramen Ovale Closure Following Cryptogenic Stroke: Any Ethnic Differences?

Introduction: Patent foramen ovale (PFO), a congenital cardiac anomaly, is implicated in the etiology of cryptogenic strokes, particularly among younger patients. Given the complex interplay of genetic and environmental factors influencing stroke risk and outcomes, it is critical to evaluate these variables within different ethnic groups. This study aims to compare demographic, clinical, and transthoracic echocardiographic (TTE) characteristics associated with PFO closure following a neurological event between Arab and Jewish populations in Israel.

Material and Method: We included 170 patients from HaEmek Medical Center who underwent PFO closure following cryptogenic stroke between January 2015 and October 2024. We retrospectively analyzed variables such as age, sex, cardiovascular risk factors, stroke type, brain CT findings, neurological sequelae and echocardiographic parameters including anatomical features of PFO.

Results and discussion: The study population was divided according to ethnicity, including 90 Arab and 80 Jewish patients. Arab patients were younger (48.9 ± 10.0 years vs. 55.3 ± 10.4, p<0.001). No significant differences were observed in additional baseline characteristics including diabetes mellitus, hypertension and hyperlipidemia. In Jewish group, TTE analysis revealed larger average amount of bubble transition through the PFO (5.13 ± 6.2 vs. 10.18 ± 40.0, p=0.022). Other TTE parameters including inter-atrial aneurysm, and bubble transition at rest or Valsalva were similar in both groups.

Conclusion: This study presents a unique analysis comparing PFO patients from Arab and Jewish populations. Apart from differences in age and the number of bubbles passing though the PFO, no significant differences were found between the two groups.