To compare the prevalence of echocardiographic findings between patients with migraine with aura (MwA) and without aura (MwoA) and to investigate their ability to predict future adverse vascular events.

Migraine is associated with a higher risk of adverse vascular events. In patients with migraine, there is also a higher prevalence of certain echocardiographic findings such as patent foramen ovale. However, little has been reported for other echocardiographic features, and their association with adverse vascular events is unknown.

In this retrospective cohort study, adult patients with migraine who had transthoracic echocardiogram (TTE) from 2000 to 2020 were identified. The first TTE was defined as the index TTE. Using our institution’s echocardiography dictionary which contained >2000 findings, we compared the findings between MwA and MwoA. We then used the findings as predictors of a composite outcome of adverse vascular events including acute myocardial infarction, acute ischemic stroke, venous thromboembolism and death.

A total of 12778 patients were included. Mean age was 47.2 ± 16.2 years, and 2619 (20.5%) were male. The median follow-up was 64 months, and 3094 (24.2%) had adverse vascular events. Overall, patients with MwA had higher prevalence of shunt, regional wall motion abnormalities (RWMA) and abnormalities in all valves and chambers on index TTE. Multivariable Cox regression models showed that, after adjustment for age, sex, aura and baseline comorbidities, RWMA (adjusted hazard ratio [aHR]: 1.51 [1.26–1.80]) and abnormalities in left ventricle (HR: 1.34 [1.24–1.46]), tricuspid valve (aHR: 1.15 [1.06–1.24]), right atrium (aHR: 1.14 [1.04–1.26]) and right ventricle (aHR: 1.52 [1.34–1.72]) were associated with increased risk of adverse vascular events.

Our results, based on a detailed echocardiographic registry, showed that many subtle cardiac anatomic and physiologic abnormalities might contribute to adverse vascular outcomes in patients with migraine.