From the Guidelines
The RoPE score is a crucial tool for determining the likelihood of a patent foramen ovale (PFO) being responsible for a cryptogenic stroke, with scores ranging from 0 to 10 and higher scores indicating a greater probability of PFO-mediated paradoxical embolism. The score considers several key factors, including age, presence of cortical infarct on imaging, and history of hypertension, diabetes, and prior stroke or TIA, as outlined in the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack 1.
Key Factors in RoPE Score
- Age: younger patients receive more points
- Presence of cortical infarct on imaging
- History of hypertension
- History of diabetes
- Prior stroke or TIA
Interpretation of RoPE Score
The RoPE score attributable fraction is highly correlated with the risk reduction of device closure compared with medical therapy in randomized trials, with scores of 9 to 10 indicating an estimated attributable fraction or probability that the PFO is stroke related of 88% (95% CI 83–91) 1.
Clinical Application
A higher RoPE score suggests a greater likelihood that the PFO is causally related to the stroke, which can inform decisions about PFO closure. For example, a RoPE score of 7 or higher may indicate a approximately 70% or greater probability that the PFO is causally related to the stroke, making PFO closure a more likely beneficial option for the patient.
From the Research
RoPE Score Explanation
The RoPE score is a method used to estimate the probability that a patent foramen ovale (PFO) is causally related to a stroke, rather than an incidental finding 2. It is calculated based on various factors, including patient characteristics and neuroimaging findings.
Factors Affecting RoPE Score
Several studies have investigated the factors that affect the RoPE score, including:
- Patient characteristics, such as age and smoking status 3
- Neuroimaging findings, such as cortical infarction and left atrial dimensions 2, 3
- Laboratory indicators, such as total cholesterol and low-density lipoprotein-cholesterol (LDL-C) levels 4
- Clinical presentation, such as the Oxfordshire Community Stroke Project (OCSP) classification 5
Clinical Applications of RoPE Score
The RoPE score has several clinical applications, including:
- Predicting the probability of a pathogenic PFO in patients with cryptogenic stroke 2, 6
- Identifying patients who are likely to benefit from PFO closure 2, 6
- Stratifying patients with cryptogenic stroke into different risk categories 5
- Evaluating the risk of recurrent ischemic events after PFO closure 3
Modified RoPE Score
A modified RoPE score has been proposed, which incorporates additional risk factors, such as LDL-C levels and transverse diameter of the left atrium 4. This modified score has been shown to exhibit superior performance in assessing the risk of PFO-related stroke compared to the original RoPE score.
Key Findings
Key findings from the studies include:
- The RoPE score is highly correlated with the relative risk reduction of device versus medical therapy in patients with cryptogenic stroke and PFO 2
- A higher RoPE score is associated with a lower risk of recurrent ischemic events after PFO closure 3
- The modified RoPE score exhibits superior performance in assessing the risk of PFO-related stroke compared to the original RoPE score 4