{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:35:54Z","timestamp":1787016954129,"version":"build-2736575974"},"reference-count":34,"publisher":"BMJ","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[2006,9]]},"abstract":"<jats:p>\n                    <jats:bold>Objective:<\/jats:bold>\n                    To investigate the frequency of acute stroke in patients with a recent travel history and to analyse risk factors, stroke patterns and presence of a patent foramen ovale (PFO) in this patient group.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design:<\/jats:bold>\n                    One-year prospective observational study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting:<\/jats:bold>\n                    Single-centre study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Enrolling all patients presenting with a first cerebral ischaemia and complementing the usual history with a standardised travel history.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Of 338 patients with acute stroke, 42 had a positive travel history (PTH) (12.4%). Patients with a PTH were significantly younger (56.6 (SD 13) years) than patients (66.9 (13.2) years, p \u200a=\u200a 0.0001) with a negative travel history (NTH). Frequency of PFO in the PTH group (13; 44.8%) was significantly higher than in the NTH group (7; 10.8%) (p \u200a=\u200a 0.0001), even after patients were dichotomised into two age groups (younger and older than median of all patients: 31%\n                    <jats:italic>v<\/jats:italic>\n                    6.1%, p \u200a=\u200a 0.007 and 13.8%\n                    <jats:italic>v<\/jats:italic>\n                    4.6%, p \u200a=\u200a 0.022, respectively). PTH patients had fewer stroke risk factors (2.2 (1.4)\n                    <jats:italic>v<\/jats:italic>\n                    3.3 (1.6), p \u200a=\u200a 0.0001) and a different risk profile with a lower frequency of diabetes (11.9%\n                    <jats:italic>v<\/jats:italic>\n                    31.4%, p \u200a=\u200a 0.009), hypertension (52.4%\n                    <jats:italic>v<\/jats:italic>\n                    78.7%, p \u200a=\u200a 0.0001), atrial fibrillation (7.1%\n                    <jats:italic>v<\/jats:italic>\n                    22%, p \u200a=\u200a 0.025) and others (16.7%\n                    <jats:italic>v<\/jats:italic>\n                    38.9%, p \u200a=\u200a 0.005). In contrast, PTH patients had significantly more cardioembolic (35.7%\n                    <jats:italic>v<\/jats:italic>\n                    19.3%, p \u200a=\u200a 0.023) and cryptogenic strokes (50%\n                    <jats:italic>v<\/jats:italic>\n                    19.9%, p \u200a=\u200a 0.0001) and more often ischaemia in the territory of the posterior cerebral artery (29.6%\n                    <jats:italic>v<\/jats:italic>\n                    6.3%, p \u200a=\u200a 0.0001).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    The finding that more PTH patients had a PFO and a cardioembolic stroke pattern but that fewer had other typical stroke risk factors led to the hypothesis that PFO is a risk factor for economy class stroke syndrome.\n                  <\/jats:p>","DOI":"10.1136\/hrt.2005.077131","type":"journal-article","created":{"date-parts":[[2006,2,1]],"date-time":"2006-02-01T11:32:32Z","timestamp":1138793552000},"page":"1265-1268","source":"Crossref","is-referenced-by-count":19,"title":["Increased frequency of cardioembolism and patent foramen ovale in patients with stroke and a positive travel history suggesting economy class stroke syndrome: \n            Table 1"],"prefix":"10.1136","volume":"92","author":[{"given":"J G","family":"Heckmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Stadter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U","family":"Reulbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Duetsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U","family":"Nixdorff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Ringwald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2006,1,31]]},"reference":[{"key":"2025100703054672000_92.9.1265.1","doi-asserted-by":"publisher","DOI":"10.4065\/79.1.79"},{"key":"2025100703054672000_92.9.1265.2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2004.052233"},{"key":"2025100703054672000_92.9.1265.3","first-page":"235","volume":"2","year":"1993","journal-title":"Heart Dis Stroke"},{"key":"2025100703054672000_92.9.1265.4","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2004.052217"},{"key":"2025100703054672000_92.9.1265.5","unstructured":"Heckmann JG, Niedermeier W, Brandt-Pohlmann M, et al. [Detection of patent foramen ovale: transesophageal echocardiography and transcranial Doppler sonography with ultrasound contrast media are \u201csupplementary, not competing, diagnostic methods\u201d]. 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[Brain infarctions caused by paradoxical embolism during long-distance flights]. 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