BACKGROUND: Pulmonary embolism (PE) is a common and potentially life-threatening diagnosis when a certain amount of thrombotic mass obstructs blood flow through the pulmonary circulation. The finding of acute and subacute ischaemic foci on magnetic resonance imaging (MRI) of the brain in a group of patients with this diagnosis in whom we demonstrate the presence of patent foramen ovale (PFO) by transoesophageal echocardiography (TEE) is surprisingly high. METHODS: A total of 129 patients with a diagnosis of pulmonary embolism (confirmed by computed tomography with contrast agent, CTA) who consented to further examination were examined by transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) with contrast agent, underwent magnetic resonance imaging of the brain according to a specific protocol, and underwent a comprehensive baseline laboratory examination. RESULTS: In our group of 129 patients, we found the presence of PFO in 36.4% (n=47) of them. A total of 5.4% (n=7) patients had asymptomatic acute and subacute ischaemic changes on brain MRI; 6 of them had concomitant PFO. The statistically significant correlation between troponin levels and the presence of pathological findings on MRI and the trend of a similar correlation for NT-proBNP values is also very interesting finding. CONCLUSIONS: The association between the presence of PFO and the occurrence of symptomatic or asymptomatic findings on brain MRI is a well-known fact (the issue of paradoxical embolism) but the high frequency of acute and subacute lesions on brain MRI in the group of patients with a diagnosis of acute PE is surprising.

Department of Internal Medicine 1 Cardiology University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Department of Radiology University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

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Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020;41(4):543-603. DOI

Stein PD, Hull RD, Pineo G. Strategy that includes serial noninvasive leg tests for diagnosis of thromboembolic disease in patients with suspected acute pulmonary embolism based on data from PIOPED. Prospective Investigation of Pulmonary Embolism Diagnosis. Arch Intern Med 1995;155(19):2101-4. DOI

Homma S, Messe SR, Rundek T, Sun YP, Franke J, Davidson K, Sievert H, Sacco RL, Di Tullio MR. Patent foramen ovale, Nat Rev Dis Primers 2016;2:15086. DOI

Wessler BS, Thaler DE, Ruthazer R, Weimar C, Di Tullio MR, Elkind MS, Homma S, Lutz JS, Mas JL, Mattle HP, Meier B, Nedeltchev K, Papetti F, Di Angelantonio E, Reisman M, Serena J, Kent DM. Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale: analysis of putative high-risk features from the risk of paradoxical embolism database. Circ Cardiovasc Imaging 2014;7(1):125-31. DOI

Konstantinides S, Geibel A, Kasper W, Olschewski M, Blümel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation 1998;97(19):1946-51. DOI

Clergeau MR, Hamon M, Morello R, Saloux E, Viader F. Silent cerebral infarcts in patients with pulmonary embolism and a patent foramen ovale: a prospective diffusion-weighted MRI study. Stroke 2009;40(12):3758-62. DOI

Goliszek S, Wiśniewska M, Kurnicka K, Lichodziejewska B, Ciurzyński M, Kostrubiec M, Gołębiowski M, Babiuch M, Paczynska M, Koć M, Palczewski P, Wyzgał A, Pruszczyk P. Patent foramen ovale increases the risk of acute ischemic stroke in patients with acute pulmonary embolism leading to right ventricular dysfunction. Thromb Res 2014;134(5):1052-6. doi: 10.1016/j.thromres.2014.09.013 PubMed DOI

Doyen D, Castellani M, Moceri P, Chiche O, Lazdunski R, Bertora D, Cerboni P, Chaussade C, Ferrari E. Patent foramen ovale and stroke in intermediate-risk pulmonary embolism. Chest 2014;146(4):967-73. doi: 10.1378/chest.14-0100 PubMed DOI

Bücke P, Cohen JE, Horvath T, Cimpoca A, Bhogal P, Bäzner H, Henkes H. What You Always Wanted to Know about Endovascular Therapy in Acute Ischemic Stroke but Never Dared to Ask: A Comprehensive Review. Rev Cardiovasc Med 2022;23(10):340. DOI

Kral M, Sanak D, Veverka T, Hutyra M, Vidnis D, Kuncarova A, Bartkova A, Dornak T, Svabova M, Kubickova V, Zapletalova J, Herzig R, Skoloudik D. Troponin T in acute ischemic stroke. Am J Cardiol 2013;112(1):117-21. DOI

Kral M, Sanak D, Veverka T, Hutyra M, Vindis D, Bartkova A, Kuncarova A, Dornak T, Cechakova E, Herzig R, Langova K, Kanovsky P, Skoloudik D. Troponin T: correlation with location and volume of acute brain infarction. Int J Cardiol 2015;181:127-32. DOI

Sanak D, Hutyra M, Kral M, Spacek M, Bartkova A. Soumrak kryptogenni ischemicke CMP - kardioembolizace je nejcastejsi příčina. Cesk Slov Neurol N 2018;81/114(3):290-7. (In Czech) DOI