{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T12:33:27Z","timestamp":1759581207880},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,7,22]],"date-time":"2015-07-22T00:00:00Z","timestamp":1437523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2016,2]]},"abstract":"Background and Purpose<\/jats:title>Cardio\u2010embolic phenomenon is believed to underlie a significant proportion of cryptogenic strokes. We recently showed that intrapulmonary shunt (IPS<\/jats:styled-content>) was associated with cryptogenic stroke and transient ischemic attack (TIA<\/jats:styled-content>). We hypothesized that patients with prior cryptogenic stroke or TIA<\/jats:styled-content> that had an IPS<\/jats:styled-content> were at a higher risk for recurrent ischemic events.<\/jats:p><\/jats:sec>Methods<\/jats:title>The population included subjects with cryptogenic cerebrovascular accident (CVA<\/jats:styled-content>) or TIA<\/jats:styled-content>. Inclusion criteria were age \u226518\u00a0years, sinus rhythm, and clinically indicated transesophageal echocardiography (TEE<\/jats:styled-content>). Exclusion criteria were hemorrhagic CVA<\/jats:styled-content>, septal defect, and patent foramen. Patients were followed from index TEE<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 71 patients, 8 were lost to follow\u2010up. A total of 23 patients had and 40 were without IPS<\/jats:styled-content>. Average follow\u2010up duration was 38.3\u00a0\u00b1\u00a019.2\u00a0months. Groups were similar at baseline. There was no significant difference in the recurrence of ischemic CVA<\/jats:styled-content> or TIA<\/jats:styled-content> in the IPS<\/jats:styled-content> versus non\u2010IPS<\/jats:styled-content> groups (0% vs. 7.5%; P\u00a0=\u00a0NS<\/jats:styled-content>). There was no difference between the incidence of hemorrhagic CVA<\/jats:styled-content> in the IPS<\/jats:styled-content> and non\u2010IPS<\/jats:styled-content> groups (4.3% vs. 5.0%; P\u00a0=\u00a0NS<\/jats:styled-content>). The proportion of patients on warfarin in the IPS<\/jats:styled-content> group was significantly higher compared to the non\u2010IPS<\/jats:styled-content> group (17.4% vs. 0%; P\u00a0<\u00a00.05).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Patients with IPS<\/jats:styled-content> and cryptogenic stroke or TIA<\/jats:styled-content> did not have a higher recurrence of ischemic cerebral events. Warfarin was significantly higher at follow\u2010up in the IPS<\/jats:styled-content> compared to the non\u2010IPS<\/jats:styled-content> group, which may explain these findings. A study randomizing patients with IPS<\/jats:styled-content> and cryptogenic stroke or TIA<\/jats:styled-content> to warfarin or no warfarin would be of great interest.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.13017","type":"journal-article","created":{"date-parts":[[2015,7,22]],"date-time":"2015-07-22T09:55:16Z","timestamp":1437558916000},"page":"276-280","source":"Crossref","is-referenced-by-count":3,"title":["Risk of Recurrent Neurologic Stroke or Transient Ischemic Attack in Patients with Cryptogenic Stroke and Intrapulmonary Shunt"],"prefix":"10.1111","volume":"33","author":[{"given":"Rahul S.","family":"Sinha","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Medicine University of Louisville Louisville Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeeshan","family":"Hussain","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Medicine University of Louisville Louisville Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nirmanmoh","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Medicine University of Louisville Louisville Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus F.","family":"Stoddard","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Medicine University of Louisville Louisville Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.187998"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410250410"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.08.038"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.4065\/81.5.602"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.08.063"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.04.004"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.1.35"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(88)92944-3"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198805053181802"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.10.044"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181aa2a19"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.593376"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1211716"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1301440"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-200194070-00016"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e31802f8da1"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2007.087452"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2011.00641.x"},{"key":"e_1_2_7_20_1","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1056\/NEJMoa011503","article-title":"Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both","volume":"345","author":"Mas JL","year":"2001","journal-title":"New Engl J Med"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.31.10.2407"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-1331.2003.00561.x"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000017498.88393.44"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fecho.13017","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.13017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T19:25:17Z","timestamp":1695497117000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.13017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,7,22]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2016,2]]}},"alternative-id":["10.1111\/echo.13017"],"URL":"https:\/\/doi.org\/10.1111\/echo.13017","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,7,22]]}}}