Response to Letter Regarding Article, “Transesophageal Echocardiography in Cryptogenic Stroke and Patent Foramen Ovale Analysis of Putative High-Risk Features From the Risk of Paradoxical Embolism Database”
Schuchlenz1 makes important observations that help frame the conclusions we reached through analysis of the transesophageal echocardiography data from the Risk of Paradoxical Embolism (RoPE) database and appropriately highlights some of the limitations of this data set. Specifically, important anatomic features (presence or absence of a prominent eustachian valve) were not routinely reported across the component databases. Additionally, microbubbles were routinely injected via the antecubital vein, a site that Schuchlenz1 correctly identifies as correlating less well with anatomic size.
To create our RoPE database,2 component studies were combined and data were harmonized with the goals of improving on the methodological and statistical limitations …