SAFOP Study. Patent Foramen Ovale and SARS-CoV-2 Disease: Could They Be Considered Risk Factors for Suffering an Ischemic Vascular Accident Due to Paradoxical Embolism? Does sex matter?

Objective: To describe whether there is an increased risk of cryptogenic ischemic stroke in patients with a patent foramen ovale (PFO) and SARS-CoV-2 infection in the Gandía health department. Method: Retrospective observational study conducted in the Primary Care Team (EAP) and Hospital Emergency-Cardiology Departments in the cardiovascular problems branch of the La Safor area of Valencia, Gandía department. A total of 335 selected patients were studied. These patients had to have experienced cryptogenic ischemic stroke associated with a patent foramen ovale and meet the inclusion criteria (patient >18 years, <65 years, and patient from the Gandía health department), during the years 2020, 2021, and 2022. Variables: age, sex, arterial hypertension, diabetes mellitus, cholesterol, patent foramen ovale and its structural characteristics, ischemic stroke, atrial septal aneurysm, SARS-CoV-2 infection. In terms of design, binary logistic regression models were performed, as well as a descriptive study where quantitative variables were described with the mean, standard deviation, and median; qualitative variables by frequency distribution. Subsequently, a multivariate model analysis was performed including variables with statistically significant or potentially relevant effects. Results: PFO was detected more frequently among patients with COVID-19 (p<0.026) and cryptogenic stroke, with a positive result in 41.5% of PFO patients compared to 27.4% in non- PFO patients. Regarding sex, while 60% of women with PFO are positive for SARS-CoV-2, this percentage is reduced to 33.3% in men (p=0.044). In a comparative study according to PFO characteristics (PFO, medium-large PFO, ASA, PFO+ASA, medium-large PFO + ASA) we found statistical significance only in those patients with cryptogenic stroke, COVID-19 infection, and a medium-large PFO without ASA (p<0.02). Conclusions: Women with PFO and cryptogenic stroke are diagnosed more frequently with SARS-CoV-2 than men. Patients in our health area who have medium-large PFO have an increased risk of experiencing an embolic cerebral accident after SARS-CoV-2 infection. This underscores the need to identify these patients in primary care, neurology, and cardiology consultations to ensure closer monitoring and develop multidisciplinary action protocols.