A Modified Anatomical-Functional-RoPE (AF-RoPE) Score Improves Patient Selection for Patent Foramen Ovale Closure

Abstract

Background The RoPE score calculator has been suggested to stratify patients in whom the patent foramen ovale (PFO) should be considered a causative factor for stroke. Methods We reviewed the medical and instrumental data of 1040 consecutive patients (mean age 47.3±17.1 years, females) prospectively enrolled in two centres over a 13 year period for management of PFO in order to select anatomic and functional parameters to be incorporated in a modified RoPE score. A scoring system (AF-RoPE) was build up and applied in a prospective blinded fashion to a cohort of 406 consecutive patients (mean age 43.6 ±17. 5 years, 264 females) with cryptogenic stroke and PFO, comparing its performance with the standard RoPE. Results Multiple stepwise logistic regression analysis demonstrated that right-to-left (R-L) shunt at rest (OR 5.9), huge ASA (> 20 mm) (OR 3.9), long tunnelized PFO (> 12 mm) (OR 3.5), and massive R-L shunt (grade 5 by TCD) (OR 1.9) conferred the highest risk of recurrent stroke. The AF-RoPE score resulted in a more precise separation of patients with RoPE score 8-10. Patients with AF-RoPE score > 11 had more stroke recurrences and more diffuse area of stroke on MRI in the medical history than those ranging from 10 to 7 or less (85.2 and 68.5 % respectively, p <0.01). Conclusions The AF-RoPE score discriminates cryptogenic stroke patients who are more likely to develop recurrent stroke compared with a RoPE score between 8-10. These highest risk patients may be more likely to benefit from PFO closure.

Keywords

• patent foramen ovale
• echocardiography
• stroke
• anatomy