{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T23:38:44Z","timestamp":1783035524643,"version":"3.54.6"},"reference-count":42,"publisher":"Tohoku University Medical Press","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tohoku J. Exp. Med."],"published-print":{"date-parts":[[2025]]},"DOI":"10.1620\/tjem.2025.j056","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T18:08:44Z","timestamp":1747850924000},"page":"133-139","source":"Crossref","is-referenced-by-count":1,"title":["A High Ratio of D-1 Dimer to Brain Natriuretic Peptide and Large Right-to-Left Shunt by Contrast-Enhanced Transthoracic Echocardiography as Risk Factors for Cryptogenic Stroke in Patent Foramen Ovale"],"prefix":"10.1620","volume":"267","author":[{"given":"Fuwang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Ultrasound, the First People\u2019s Hospital of Jiashan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfang","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, the First People\u2019s Hospital of Jiashan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"622","reference":[{"key":"1","doi-asserted-by":"crossref","unstructured":"Caso, V., Turc, G., Abdul-Rahim, A.H., Castro, P., Hussain, S., Lal, A., Mattle, H., Korompoki, E., Sondergaard, L., Toni, D., Walter, S.&amp;Pristipino, C. (2024)  European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke. <i>Eur. Stroke J.<\/i>, 9, 800-834.","DOI":"10.1177\/23969873241247978"},{"key":"2","doi-asserted-by":"crossref","unstructured":"Chin, K.M., Rubin, L.J., Channick, R., Di Scala, L., Gaine, S., Galie, N., Ghofrani, H.A., Hoeper, M.M., Lang, I.M., McLaughlin, V.V., Preiss, R., Simonneau, G., Sitbon, O.&amp;Tapson, V.F. (2019)  Association of N-Terminal Pro Brain Natriuretic Peptide and Long-Term Outcome in Patients With Pulmonary Arterial Hypertension. <i>Circulation<\/i>, 139, 2440-2450.","DOI":"10.1161\/CIRCULATIONAHA.118.039360"},{"key":"3","doi-asserted-by":"crossref","unstructured":"Cho, K.K., Khanna, S., Lo, P., Cheng, D.&amp;Roy, D. (2021)  Persistent pathology of the patent foramen ovale: a review of the literature. <i>Med. J. Aust.<\/i>, 215, 89-93.","DOI":"10.5694\/mja2.51141"},{"key":"4","doi-asserted-by":"crossref","unstructured":"Dong, B., Lu, Y., He, S., Li, B., Li, Y., Lai, Q., Li, W., Ji, S., Chen, Y., Dai, L.&amp;Chen, L. (2023)  Multisite and multitimepoint proteomics reveal that patent foramen ovale closure improves migraine and epilepsy by reducing right-to-left shunt-induced hypoxia. <i>MedComm<\/i> (<i>2020<\/i>), 4, e334.","DOI":"10.1002\/mco2.334"},{"key":"5","doi-asserted-by":"crossref","unstructured":"Ekker, M.S., Verhoeven, J.I., Schellekens, M.M.I., Boot, E.M., van Alebeek, M.E., Brouwers, P., Arntz, R.M., van Dijk, G.W., Gons, R.A.R., van Uden, I.W.M., den Heijer, T., de Kort, P.L.M., de Laat, K.F., van Norden, A.G.W., Vermeer, S.E., et al. (2023) Risk Factors and Causes of Ischemic Stroke in 1322 Young Adults. <i>Stroke<\/i>, 54, 439-447.","DOI":"10.1161\/STROKEAHA.122.040524"},{"key":"6","doi-asserted-by":"crossref","unstructured":"Fraser, S., Pabst, L.&amp;Smith, F. (2023)  Stroke in the young. <i>Curr. Opin. Neurol.<\/i>, 36, 131-139.","DOI":"10.1097\/WCO.0000000000001145"},{"key":"7","doi-asserted-by":"crossref","unstructured":"Ghazal, S.N. (2017) Valsalva maneuver in echocardiography. <i>J. Echocardiogr.<\/i>, 15, 1-5.","DOI":"10.1007\/s12574-016-0310-8"},{"key":"8","doi-asserted-by":"crossref","unstructured":"Goetze, J.P., Bruneau, B.G., Ramos, H.R., Ogawa, T., de Bold, M.K.&amp;de Bold, A.J. (2020)  Cardiac natriuretic peptides. <i>Nat. Rev. Cardiol.<\/i>, 17, 698-717.","DOI":"10.1038\/s41569-020-0381-0"},{"key":"9","doi-asserted-by":"crossref","unstructured":"Gonzalez-Alujas, T., Evangelista, A., Santamarina, E., Rubiera, M., Gomez-Bosch, Z., Rodriguez-Palomares, J.F., Avegliano, G., Molina, C., Alvarez-Sabin, J.&amp;Garcia-Dorado, D. (2011)  Diagnosis and quantification of patent foramen ovale. Which is the reference technique? Simultaneous study with transcranial Doppler, transthoracic and transesophageal echocardiography. <i>Rev. Esp. Cardiol.<\/i>, 64, 133-139.","DOI":"10.1016\/j.rec.2010.10.014"},{"key":"10","doi-asserted-by":"crossref","unstructured":"Greyson, C.R. (2010) The right ventricle and pulmonary circulation: basic concepts. <i>Rev. Esp. Cardiol.<\/i>, 63, 81-95.","DOI":"10.1016\/S1885-5857(10)70012-8"},{"key":"11","doi-asserted-by":"crossref","unstructured":"Gutte, H., Mortensen, J., Jensen, C.V., von der Recke, P., Petersen, C.L., Kristoffersen, U.S.&amp;Kjaer, A. (2010)  ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism. <i>Clin. Physiol. Funct. Imaging<\/i>, 30, 466-472.","DOI":"10.1111\/j.1475-097X.2010.00967.x"},{"key":"12","unstructured":"Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders: 2nd edition. <i>Cephalalgia<\/i>, 24 Suppl 1, 9-160."},{"key":"13","doi-asserted-by":"crossref","unstructured":"Hira, K., Ueno, Y., Watanabe, M., Shimura, H., Kurita, N., Miyamoto, N., Haginiwa, H., Yamashiro, K., Hattori, N.&amp;Urabe, T. (2022)  Impact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experience. <i>BMC Neurol.<\/i>, 22, 338.","DOI":"10.1186\/s12883-022-02867-z"},{"key":"14","doi-asserted-by":"crossref","unstructured":"Ibeh, C.&amp;Elkind, M.S.V. (2021)  Stroke Prevention After Cryptogenic Stroke. <i>Curr. Cardiol. Rep.<\/i>, 23, 174.","DOI":"10.1007\/s11886-021-01604-1"},{"key":"15","doi-asserted-by":"crossref","unstructured":"Jeon, D.S., Luo, H., Iwami, T., Miyamoto, T., Brasch, A.V., Mirocha, J., Naqvi, T.Z.&amp;Siegel, R.J. (2002)  The usefulness of a 10% air-10% blood-80% saline mixture for contrast echocardiography: Doppler measurement of pulmonary artery systolic pressure. <i>J. Am. Coll. Cardiol.<\/i>, 39, 124-129.","DOI":"10.1016\/S0735-1097(01)01698-9"},{"key":"16","doi-asserted-by":"crossref","unstructured":"Kent, D.M., Ruthazer, R., Weimar, C., Mas, J.L., Serena, J., Homma, S., Di Angelantonio, E., Di Tullio, M.R., Lutz, J.S., Elkind, M.S., Griffith, J., Jaigobin, C., Mattle, H.P., Michel, P., Mono, M.L., et al. (2013) An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. <i>Neurology<\/i>, 81, 619-625.","DOI":"10.1212\/WNL.0b013e3182a08d59"},{"key":"17","doi-asserted-by":"crossref","unstructured":"Kent, D.M., Saver, J.L., Kasner, S.E., Nelson, J., Carroll, J.D., Chatellier, G., Derumeaux, G., Furlan, A.J., Herrmann, H.C., Juni, P., Kim, J.S., Koethe, B., Lee, P.H., Lefebvre, B., Mattle, H.P., et al. (2021)  Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke. <i>JAMA<\/i>, 326, 2277-2286.","DOI":"10.1001\/jama.2021.20956"},{"key":"18","doi-asserted-by":"crossref","unstructured":"Khan, M., Miller, M., McCarthy, P., Tsai, J.P., Merhi, W., Berkompas, D., Wees, N., Khan, N.I., Ahrar, A., Evans, E., Dahu, M., Gauri, A., Moelker, T., Chalfoun, N.&amp;Min, J. (2024)  Multidisciplinary Approach to Patent Foramen Ovale Closure for Cryptogenic Stroke: Brain-Heart Board Experience. <i>Neurol. Clin. Pract.<\/i>, 14, e200319.","DOI":"10.1212\/CPJ.0000000000200319"},{"key":"19","doi-asserted-by":"crossref","unstructured":"Kim, Y.D., Song, D., Nam, H.S., Lee, K., Yoo, J., Hong, G.R., Lee, H.S., Nam, C.M.&amp;Heo, J.H. (2015)  D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale. <i>Thromb. Haemost.<\/i>, 114, 614-622.","DOI":"10.1160\/TH14-12-1040"},{"key":"20","doi-asserted-by":"crossref","unstructured":"Lee, M.&amp;Oh, J.H. (2020)  Echocardiographic diagnosis of right-to-left shunt using transoesophageal and transthoracic echocardiography. <i>Open Heart<\/i>, 7, e001150.","DOI":"10.1136\/openhrt-2019-001150"},{"key":"21","doi-asserted-by":"crossref","unstructured":"Lippi, G., Bonfanti, L., Saccenti, C.&amp;Cervellin, G. (2014)  Causes of elevated D-dimer in patients admitted to a large urban emergency department. <i>Eur. J. Intern. Med.<\/i>, 25, 45-48.","DOI":"10.1016\/j.ejim.2013.07.012"},{"key":"22","doi-asserted-by":"crossref","unstructured":"Mac Grory, B., Ohman, E.M., Feng, W., Xian, Y., Yaghi, S., Kamel, H.&amp;Reznik, M.E. (2022)  Advances in the management of cardioembolic stroke associated with patent foramen ovale. <i>BMJ<\/i>, 376, e063161.","DOI":"10.1136\/bmj-2020-063161"},{"key":"23","doi-asserted-by":"crossref","unstructured":"Marriott, K., Manins, V., Forshaw, A., Wright, J.&amp;Pascoe, R. (2013)  Detection of right-to-left atrial communication using agitated saline contrast imaging: experience with 1162 patients and recommendations for echocardiography. <i>J. Am. Soc. Echocardiogr.<\/i>, 26, 96-102.","DOI":"10.1016\/j.echo.2012.09.007"},{"key":"24","doi-asserted-by":"crossref","unstructured":"Miranda, B., Fonseca, A.C.&amp;Ferro, J.M. (2018)  Patent foramen ovale and stroke. <i>J. Neurol.<\/i>, 265, 1943-1949.","DOI":"10.1007\/s00415-018-8865-0"},{"key":"25","doi-asserted-by":"crossref","unstructured":"Mojaddedi, S., Zaman, M.O., Elgendy, I.Y.&amp;Mojadidi, M.K. (2024)  Techniques for Identifying a Patent Foramen Ovale: Transthoracic Echocardiography, Transesophageal Echocardiography, Transcranial Doppler, Right Heart Catheterization. <i>Cardiol. Clin.<\/i>, 42, 473-486.","DOI":"10.1016\/j.ccl.2024.01.005"},{"key":"26","doi-asserted-by":"crossref","unstructured":"Mojadidi, M.K., Kumar, P., Mahmoud, A.N., Elgendy, I.Y., Shapiro, H., West, B., Charles, A.C., Mattle, H.P., Sorensen, S., Meier, B., Silberstein, S.D.&amp;Tobis, J.M. (2021)  Pooled Analysis of PFO Occluder Device Trials in Patients With PFO and Migraine. <i>J. Am. Coll. Cardiol.<\/i>, 77, 667-676.","DOI":"10.1016\/j.jacc.2020.11.068"},{"key":"27","doi-asserted-by":"crossref","unstructured":"Nakayama, R., Takaya, Y., Akagi, T., Watanabe, N., Ikeda, M., Nakagawa, K., Toh, N.&amp;Ito, H. (2019)  Identification of High-Risk Patent Foramen Ovale Associated With Cryptogenic Stroke: Development of a Scoring System. <i>J. Am. Soc. Echocardiogr.<\/i>, 32, 811-816.","DOI":"10.1016\/j.echo.2019.03.021"},{"key":"28","doi-asserted-by":"crossref","unstructured":"Okazaki, T., Yamamoto, Y., Yoda, K.&amp;Nagahiro, S. (2014)  The ratio of D-dimer to brain natriuretic peptide may help to differentiate between cerebral infarction with and without acute aortic dissection. <i>J. Neurol. Sci.<\/i>, 340, 133-138.","DOI":"10.1016\/j.jns.2014.03.011"},{"key":"29","doi-asserted-by":"crossref","unstructured":"Pala, E., Pagola, J., Juega, J., Francisco-Pascual, J., Bustamante, A., Penalba, A., Comas, I., Rodriguez, M., De Lera Alfonso, M., Arenillas, J.F., de Torres, R., Perez-Sanchez, S., Cabezas, J.A., Moniche, F., Gonzalez-Alujas, T., et al. (2021) B-type natriuretic peptide over N-terminal pro-brain natriuretic peptide to predict incident atrial fibrillation after cryptogenic stroke. <i>Eur. J. Neurol.<\/i>, 28, 540-547.","DOI":"10.1111\/ene.14579"},{"key":"30","doi-asserted-by":"crossref","unstructured":"Park, S., Kwon, B., Oh, J.K., Song, J.K., Lee, J.S.&amp;Kwon, S.U. (2023)  Risk of recurrent ischemic stroke in patients with patent foramen ovale: The role of D-dimer. <i>J. Stroke Cerebrovasc. Dis.<\/i>, 32, 107246.","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107246"},{"key":"31","doi-asserted-by":"crossref","unstructured":"Perera, K.S., de Sa Boasquevisque, D., Rao-Melacini, P., Taylor, A., Cheng, A., Hankey, G.J., Lee, S., Fabregas, J.M., Ameriso, S.F., Field, T.S., Arauz, A., Coutts, S.B., Arnold, M., Mikulik, R., Toni, D., et al. (2022) Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source: The Young ESUS Longitudinal Cohort Study. <i>JAMA Neurol.<\/i>, 79, 450-458.","DOI":"10.1001\/jamaneurol.2022.0048"},{"key":"32","doi-asserted-by":"crossref","unstructured":"Pradhan, N.M., Mullin, C.&amp;Poor, H.D. (2020)  Biomarkers and Right Ventricular Dysfunction. <i>Crit. Care Clin.<\/i>, 36, 141-153.","DOI":"10.1016\/j.ccc.2019.08.011"},{"key":"33","doi-asserted-by":"crossref","unstructured":"Pudusseri, A., Sanchorawala, V., Sloan, J.M., Bever, K.M., Doros, G., Kataria, S.&amp;Sarosiek, S. (2019)  Prevalence and prognostic value of D-dimer elevation in patients with AL amyloidosis. <i>Am. J. Hematol.<\/i>, 94, 1098-1103.","DOI":"10.1002\/ajh.25576"},{"key":"34","doi-asserted-by":"crossref","unstructured":"Shi, J., Gu, H., Fan, W., Xia, J.&amp;Gu, H. (2024)  Comparison of the Application Value of Transthoracic Echocardiography in Diagnosing Patent Foramen Ovale Under Different States of Stimulation: A Retrospective Study. <i>Clin. Cardiol.<\/i>, 47, e24319.","DOI":"10.1002\/clc.24319"},{"key":"35","doi-asserted-by":"crossref","unstructured":"Takaya, Y., Nakayama, R., Akagi, T., Yokohama, F., Miki, T., Nakagawa, K., Toh, N.&amp;Ito, H. (2021)  Importance of direct right-to-left shunt as high-risk patent foramen ovale associated with cryptogenic stroke. <i>Echocardiography<\/i>, 38, 1887-1892.","DOI":"10.1111\/echo.15234"},{"key":"36","doi-asserted-by":"crossref","unstructured":"Takaya, Y., Nakayama, R., Akagi, T., Yokohama, F., Miki, T., Nakagawa, K., Toh, N.&amp;Ito, H. (2022)  Importance of saline contrast transthoracic echocardiography for evaluating large right-to-left shunt in patent foramen ovale associated with cryptogenic stroke. <i>Int. J. Cardiovasc. Imaging<\/i>, 38, 515-520.","DOI":"10.1007\/s10554-021-02418-6"},{"key":"37","doi-asserted-by":"crossref","unstructured":"Tateishi, Y., Ueno, Y., Tsujino, A., Kuriki, A., Kamiya, Y., Shimizu, T., Doijiri, R., Yamaguchi, E., Kikuno, M., Shimada, Y., Takekawa, H., Koga, M., Ihara, M., Hirata, K., Hasegawa, Y., et al. (2021)  Cardiac and Echocardiographic Markers in Cryptogenic Stroke with Incidental Patent Foramen Ovale. <i>J. Stroke Cerebrovasc. Dis.<\/i>, 30, 105892.","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105892"},{"key":"38","doi-asserted-by":"crossref","unstructured":"Udovenko, A., Makogonenko, Y., Korolova, D., Druzhyna, N., Chernyshenko, V.&amp;Komisarenko, S. (2023)  Formation and elimination of soluble fibrin and D-dimer in the bloodstream. <i>Croat. Med. J.<\/i>, 64, 421-429.","DOI":"10.3325\/cmj.2023.64.421"},{"key":"39","doi-asserted-by":"crossref","unstructured":"Ueno, Y., Tanaka, R., Yamashiro, K., Shimada, Y., Kuroki, T., Hira, K., Urabe, T.&amp;Hattori, N. (2015)  Impact of BNP on cryptogenic stroke without potential embolic sources on transesophageal echocardiography. <i>J. Neurol. Sci.<\/i>, 359, 287-292.","DOI":"10.1016\/j.jns.2015.11.014"},{"key":"40","unstructured":"Uzar, E., Evliyaoglu, O., Yucel, Y., Ugur Cevik, M., Acar, A., Guzel, I., Islamoglu, Y., Colpan, L.&amp;Tasdemir, N. (2011)  Serum cytokine and pro-brain natriuretic peptide (BNP) levels in patients with migraine. <i>Eur. Rev. Med. Pharmacol. Sci.<\/i>, 15, 1111-1116."},{"key":"41","doi-asserted-by":"crossref","unstructured":"Witte, L.S., El Bouziani, A., Beijk, M.A.M., Robbers-Visser, D., Coutinho, J.M., Tijssen, J.G.P., Straver, B., Bouma, B.J.&amp;de Winter, R.J. (2024)  Persistence of residual shunt at 6 and 12 months after transoesophageal echocardiography-guided percutaneous closure of a patent foramen ovale for cryptogenic stroke. <i>Heart<\/i>, 110, 1172-1179.","DOI":"10.1136\/heartjnl-2024-323905"},{"key":"42","doi-asserted-by":"crossref","unstructured":"Yang, D.&amp;Elkind, M.S.V. (2023)  Current perspectives on the clinical management of cryptogenic stroke. <i>Expert Rev. Neurother.<\/i>, 23, 213-226.","DOI":"10.1080\/14737175.2023.2192403"}],"container-title":["The Tohoku Journal of Experimental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/tjem\/267\/2\/267_2025.J056\/_pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T04:25:58Z","timestamp":1760156758000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/tjem\/267\/2\/267_2025.J056\/_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":42,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1620\/tjem.2025.j056","relation":{},"ISSN":["0040-8727","1349-3329"],"issn-type":[{"value":"0040-8727","type":"print"},{"value":"1349-3329","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"2025.J056"}}