背景:卵圆孔未闭(PFO)与一些60岁以下患者的卒中有因果关系,特别是当它很大或与房间隔动脉瘤(ASA)相关时。60岁以后,这种联系不太清楚。我们评估了该人群中详细的房间隔解剖结构与中风的隐源性性质之间的关系。
结果:我们回顾了2016年至2021年期间因缺血性卒中而入院的所有60至80岁患者。动脉粥样硬化,小血管疾病,心脏病理学,其他原因,解剖(ASCOD)分类用于重新评估病因检查。隐源性卒中与(1)PFO存在或(2)PFO解剖类别之间的关联(无ASA的非大型PFO,带有ASA的非大型PFO,没有ASA的大型PFO,和ASA的大PFO)使用逻辑回归进行评估。在533名患者中(美国国立卫生研究院卒中量表评分中位数=1),PFO出现在152例(患病率,28.5%[95%CI,24.9-32.5])。与非隐源性卒中相比,隐源性卒中(n=218)与PFO存在相关(44.5%对17.5%;P<0.0001).在PFO患者中,间隔解剖类别与隐源性卒中相关(P=0.02),对于患有大PFO和ASA的患者具有很强的相关性(38.1%对14.5%,P=0.002)。
结论:PFO的存在与60至80岁的隐源性卒中密切相关。大PFO,ASA,他们的关联与该年龄组的隐源性卒中密切相关.我们的结果支持即使在60岁以后也进行对比超声心动图检查,尽管该人群的最佳二级预防治疗仍有待随机试验确定.
BACKGROUND: Patent foramen ovale (PFO) is causally associated with stroke in some patients younger than 60 years, especially when it is large or associated with an atrial septal aneurysm (ASA). After 60 years of age, this association is less well understood. We assessed the relationships between detailed atrial septal anatomy and the cryptogenic nature of stroke in this population.
RESULTS: We reviewed all patients aged 60 to 80 years admitted to our stroke center for ischemic stroke who underwent contrast echocardiography between 2016 and 2021. The atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection (ASCOD) classification was used to reevaluate the etiological workup. Associations between cryptogenic stroke and (1) PFO presence or (2) categories of PFO anatomy (nonlarge PFO without ASA, nonlarge PFO with ASA, large PFO without ASA, and large PFO with ASA) were assessed using logistic regression. Among 533 patients (median National Institutes of Health Stroke Scale score=1), PFO was present in 152 (prevalence, 28.5% [95% CI, 24.9-32.5]). Compared with noncryptogenic stroke, cryptogenic stroke (n=218) was associated with PFO presence (44.5% versus 17.5%; P<0.0001). Among patients with a PFO, septal anatomy categories were associated with cryptogenic stroke (P=0.02), with a strong association for patients with both large PFO and ASA (38.1% versus 14.5%, P=0.002).
CONCLUSIONS: PFO presence remains strongly associated with cryptogenic stroke between 60 and 80 years of age. Large PFO, ASA, and their association were strongly associated with cryptogenic stroke in this age group. Our results support performing contrast echocardiography even after 60 years of age, although the optimal secondary prevention therapy in this population remains to be determined in randomized trials.