BACKGROUD The role of patent foramen ovale (PFO) in cryptogenic stroke (CS) is debated. Tools to predict PFO occurrence and attributable fraction are needed to guide cost-effective diagnostics and treatment. Risk of Paradoxical Embolism (RoPE) score relies on neuroimaging findings, which might be inconclusive in up to 30% of cases. METHODS We developed a clinical-based easy tool to predict the presence and attributable fraction of PFO in CS patients, without using neuroimaging. The clinical RoPE (cRoPE) score, ranging 1-10, was elaborated through Delphi method from the original RoPE score, replacing cortical infarction with the Oxfordshire Community Stroke Project (OCSP) classification (lacunar stroke = 0 points, other subtypes = 1 point). Then, from the SISIFO (Studio Italiano di prevalenza nello Stroke Ischemico di pervietà del Forame Ovale, or Prevalence of Patent Foramen Ovale in Ischemic Stroke in Italy) study, a multicenter, prospective study on consecutive acute ischemic stroke patients (n = 1130) classified by Trial of Org 10172 in Acute Stroke Treatment (TOAST) and OCSP criteria and undergoing PFO testing, we selected the VV-CDC cohort (Vibo Valentia, Città di Castello, n = 323) to test the accuracy of cRoPE in predicting PFO detection. We compared cRoPE with RoPE to verify cRoPE reliability. Finally, we tested, through ROC analysis, the performance of cRoPE depending on TOAST classification. RESULTS Overall, PFO was detected in 21% in VV-CDC and in 23.4% in remaining SISIFO cohort (n = 807). cRoPEAUC and RoPEAUC were similar in VV-CDC. cRoPE performance was comparable with RoPE among CS (cRoPEAUC 0.76, 95%CI 0.67-0.85, RoPEAUC 0.75, 95%CI 0.66-0.84). Moving to the remaining SISIFO cohort, cRoPE confirmed satisfactory accuracy in predicting PFO detection in CS patients (cRoPEAUC 0.71, 95%CI 0.66-0.78, p = 0.032). CONCLUSIONS Conclusions: cRoPE might help in stratification of patients with CS, allowing accurate esteem of the likelihood of PFO to be found, especially in cases when neuroimaging is inconclusive.

中文翻译：

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临床 RoPE (cRoPE) 评分可预测中风患者的卵圆孔未闭检测：一项多中心观察性研究。

背景 卵圆孔未​​闭 (PFO) 在隐源性卒中 (CS) 中的作用存在争议。需要预测 PFO 发生率和归因分数的工具来指导具有成本效益的诊断和治疗。反常栓塞风险 (RoPE) 评分依赖于神经影像学检查结果，这在多达 30% 的病例中可能是不确定的。方法 我们开发了一种基于临床的简单工具来预测 CS 患者中 PFO 的存在和归因分数，而无需使用神经影像学。临床 RoPE (cRoPE) 评分范围为 1-10，由原始 RoPE 评分通过 Delphi 方法详细阐述，用牛津郡社区卒中项目 (OCSP) 分类代替皮质梗死（腔隙性卒中 = 0 分，其他亚型 = 1 分） . 然后，从 SISIFO（Studio Italiano di prevalenza nello Stroke Ischemico di pervietà del Forame Ovale，或意大利缺血性卒中卵圆孔未闭的患病率）研究，一项多中心前瞻性研究，对按照 Org 10172 在急性卒中治疗 (TOAST) 和 OCSP 标准中分类并接受 PFO 测试的连续急性缺血性卒中患者 (n = 1130) 进行分类，我们选择了 VV-CDC 队列（Vibo Valentia，Città di Castello，n = 323）来测试 cRoPE 在预测 PFO 检测方面的准确性。我们将 cRoPE 与 RoPE 进行了比较，以验证 cRoPE 的可靠性。最后，我们通过 ROC 分析测试了 cRoPE 根据 TOAST 分类的性能。结果 总体而言，在 VV-CDC 中检测到 PFO 的比例为 21%，在剩余的 SISIFO 队列中检测到 PFO 的比例为 23.4%（n = 807）。VV-CDC 中的 cRoPEAUC 和 RoPEAUC 相似。cRoPE 性能与 CS 中的 RoPE 相当（cRoPEAUC 0.76, 95%CI 0.67-0.85, RoPEAUC 0.75, 95%CI 0.66-0.84）。转移到剩余的 SISIFO 队列，cRoPE 证实了在预测 CS 患者中 PFO 检测方面的令人满意的准确性（cRoPEAUC 0.71, 95%CI 0.66-0.78, p = 0.032）。结论 结论：cRoPE 可能有助于对 CS 患者进行分层，从而准确评估发现 PFO 的可能性，尤其是在神经影像学尚无定论的情况下。