房间隔动脉瘤(ASA)在卵圆孔未闭(PFO)患者的隐源性卒中(CS)中起重要作用,但其作用在现有文献中仍未完全阐明。我们试图评估ASA对PFO患者CS风险的贡献,基于迄今为止发表的研究,通过系统评价和荟萃分析。文献检索,基于PubMed,谷歌学者和EMBASE数据库,是为了定位文章,2000年至2021年出版了英语,分析了ASA和CS之间的关系。最终研究于2021年9月进行。排除重复项后,共检索到577篇文章。初步筛选排除了215篇文章,因为它们不符合纳入标准,留下362篇文章评估资格。随后,在对全文文章进行评估之后,354项被排除在外,8项调查符合纳入标准。总的来说,822名患者(平均年龄48.3岁)纳入审查手稿,男性患病率为48.7%,经典心血管危险因素分布正常。ASA出现在25.3%(208名受试者)的患者中,而在24.3%(200名受试者)的患者中观察到PFO+ASA的关联。与没有ASA的PFO患者相比,具有较高的CS风险(奇数比:3.38,95%CI:2.72-5.51,p<0.001,I2=4.3%,).相对漏斗图没有显示任何明显的不对称性,确认不存在发表偏见。我们更新的元分析提高了ASA对卵圆孔未闭患者卒中的重要性,在有症状的PFO患者中,有三分之一的患者存在,它赋予了3.38的额外奇数比率。
Atrial septal aneurysms (ASA) play an important role in cryptogenic stroke (CS) in patients with patent foramen ovale (PFO) but its contribution remains still not fully clarified in current literature. We sought to evaluate the contribution of ASA to the risk of CS in PFO patients based on studies published so far by means of a systematic
review and metanalysis. A literature search, based on PubMed, Google Scholar and EMBASE databases, was performed to locate articles, published English language between 2000 and 2021, analysing the relationship between ASA and CS. The final research was conducted in September 2021. A total of 577 articles were retrieved after excluding duplicates. The initial screening excluded 215 articles because they did not meet inclusion criteria, leaving 362 articles to assess for eligibility. Subsequently, after evaluation of the full-text articles, 354 were excluded and 8 investigations met the inclusion criteria. Overall, 822 patients (mean age 48.3 years) were enrolled in the reviewed manuscripts with a prevalence of males of 48.7% and a normal distribution of the classical cardiovascular risk factors. ASA was present in 25.3% (208 subjects) of the patients enrolled, while the association of PFO+ASA was observed in 24.3% (200 subjects) of patients enrolled. PFO Patients with ASA were at higher risk of CS compared to those without (odd ratio: 3.38, 95% CI: 2.72-5.51, p<0.001, I2=4.3%,). The relative funnel plot did not show any evident asymmetry, confirming absence of publication bias. Our updated metanalysis enhances the importance of ASA contribution to stroke in patients with patent foramen ovale, being present in a third of patients with symptomatic PFO to whom it confers an additional odd ratio of 3.38.