卵圆孔未闭(PFO)伴房间隔动脉瘤(ASA)已被确定为隐源性中风的危险因素。有先兆偏头痛(MA)的患者似乎有无症状性脑梗死的风险,这可能与PFO的存在有关。然而,MA和PFO与ASA之间的关联从未报道过.我们在一项大型观察研究中检查了这种关联。
患者(>18年)在我们的门诊4年内接受了经食管超声心动图激动性盐水(cTEE)的患者符合纳入标准。在cTEE之前,他们收到了经过验证的头痛问卷。根据国际头痛标准,两名神经科医生诊断有或没有先兆的偏头痛。共有889名患者(平均年龄56.4±14.3岁,41.7%的妇女)被包括在内。PFO的存在率为23.2%,2.7%的孤立ASA,PFO和ASA为6.9%。偏头痛的发生率为18.9%;MA的发生率为8.1%。与无偏头痛的患者相比,MA患者中ASA的PFO患病率明显更高(18.1%vs6.1%;OR3.72,95%CI1.86-7.44,P<0.001)。然而,无ASA的PFO与MA无显著相关性(OR1.50,95%CI0.79-2.82,P=0.21)。有趣的是,ASA的PFO与MA密切相关(OR2.71,95%CI1.23-5.95,P=0.01)。
在这项大型观察研究中,PFO伴ASA仅与MA显著相关。PFO封堵研究应集中于这种特定的心房内异常。
A patent foramen ovale (PFO) with atrial septal aneurysm (ASA) has been identified as a risk factor for cryptogenic stroke. Patients with migraine with aura (MA) appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between MA and PFO with ASA has never been reported. We examined this association in a large observational
study.
Patients (>18 years) who underwent an agitated saline transesophageal echocardiography (cTEE) at our outpatient clinics within a timeframe of 4 years were eligible to be included. Before cTEE they received a validated headache questionnaire. Two neurologists diagnosed migraine with or without aura according to the International Headache Criteria. A total of 889 patients (mean age 56.4±14.3 years, 41.7% women) were included. A PFO was present in 23.2%, an isolated ASA in 2.7%, and a PFO with ASA in 6.9%. The occurrence of migraine was 18.9%; the occurrence of MA was 8.1%. The prevalence of PFO with ASA was significantly higher in patients with MA compared to patients without migraine (18.1% vs 6.1%; OR 3.72, 95% CI 1.86-7.44, P<0.001). However, a PFO without ASA was not significantly associated with MA (OR 1.50, 95% CI 0.79-2.82, P=0.21). Interestingly, a PFO with ASA was strongly associated with MA (OR 2.71, 95% CI 1.23-5.95, P=0.01).
In this large observational
study, PFO with ASA was significantly associated with MA only. PFO closure studies should focus on this specific intra-atrial anomaly.