ADD-ONS / SCALES AND SCORES
AF-RoPE score
Anatomical-Functional Risk of Paradoxical Embolism score
David Goldemund M.D.
Updated on 04/07/2024, published on 11/12/2022
Updated on 04/07/2024, published on 11/12/2022
- the discovery of a patent foramen ovale (PFO) in an individual stroke patient with an otherwise occult etiology is not synonymous with the diagnosis of paradoxical embolism
- the RoPE and improved AF-RoPE scores were introduced to help establish the relationship between cryptogenic stroke and PFO
- published data indicate that the RoPE score identifies cryptogenic stroke patients who are likely to have a pathogenic PFO
- the AF-RoPE score enables a more precise separation of patients with a RoPE score of 8-10 using anatomical and functional features (Rigatteli, 2017)
- it was demonstrated that right-to-left (R-L) shunt at rest, huge ASA (> 20 mm) ), long-tunnel PFO (> 12 mm), and massive R-L shunt on TCD/TCCD bubble test represent the highest risk of recurrent stroke
- patients with AF-RoPE score >11 had more stroke recurrences and more strokes on baseline MRI than those ranging from 10 to 7 or less
- large population studies are needed to validate this score for efficacy and long-term outcomes
- step 1 – use the AF-RoPE score to predict which patients are likely to have had cryptogenic strokes that are attributable to PFO
- step 2 – include other factors to decide whether PFO should be closed
| Characteristic | Points |
| no history of hypertension | 1 |
| no history of diabetes | 1 |
| no history of prior stroke or TIA | 1 |
| nonsmoker | 1 |
| cortical infarct on imaging | 1 |
| Functional and anatomical parameters |
|
| Curtain-type shunt |
1 |
| Permanent shunt (before Valsalva) |
2 |
| ASA 3-5 |
2 |
| long-tunnel PFO |
2 |
| Age |
|
| 18-29 | 5 |
| 30-39 | 4 |
| 40-49 | 3 |
| 50-59 | 2 |
| 60-69 | 1 |
|
≥ 70
|
0 |
| Points (0-17) | |
- maximum score 17
- patient < 30 years without vascular risk factors and a history of previous stroke/TIA
- cortical infarct
- long-tunnel PFO + permanent curtain-type shunt
- minimum score 0 – patient ≥ 70 years with vascular risk factors and subcortical lacunar infarct
| Variables | AF-RoPE | ||
| ≤ 7 | 8-10 | ≥ 11 | |
| History of recurrent stroke | 10% | 48% | 85% |
| Multiple ischemic lesions on baseline MRI | 3.4% | 29% | 68,5% |
| RoPE score | The probability that PFO is the cause of stroke (95% CI)) | Estimated stroke/TIA recurrence at 2 years |
| 0-3 | 0% (0–4) | 20% (12–28) |
| 4 | 38% (25–48) | 12% (6–18) |
| 5 | 34% (21–45) | 7% (3–11) |
| 6 | 62% (54–68) | 8% (4–12) |
| 7 | 72% (66–76) | 6% (2–10) |
| 8 | 84% (79–87) | 6% (2–10) |
| 9-10 | 88% (83–91) | 2% (0–4) |
