Mattioli Anna Vittori, Bonetti Lorenzo, Aquilina Michele, Oldani Antonio, Longhini Carlo, Mattioli Giorgio
Department of Cardiology, University of Modena, Modena, Italy.
Cerebrovasc Dis. 2003;15(1-2):4-10. doi: 10.1159/000067114.
Atrial septal aneurysm (ASA) has been considered a potential source of cardiogenic embolism for many years. The ASA Multicenter Italian (ASA-MI) Study evaluated the prevalence and characteristics of ASA in patients with stroke and normal carotid arteries compared with control patients without stroke. The purpose of the present study was to evaluate the frequency of ASA and the association with patent foramen ovale (PFO) in the subgroup of younger patients (aged less than 55 years) included in the ASA-MI Study.
The ASA-MI Study included 606 patients, enrolled between November 1990 and December 1996: 245 patients with a previous cerebral embolic attack and normal carotid study and a control group of 316 patients. They all underwent transthoracic and transesophageal echocardiography. The subgroup of younger patients aged less than 55 years included 90 patients (61 men and 29 women of mean age 49 +/- 5 years) (group AY). This group was evaluated and compared with an age- and sex-matched control population (61 men; of mean age 48 +/- 6 years) (group BY).
The prevalence of ASA was 48.8% (95% confidence interval 40-61) in group AY and 22.2% in the group BY (95% confidence interval 18-33) (chi(2) = 5.968; p = 0.01). Morphological features were similar in the 2 groups of patients. ASA involved the entire septum in 52% of patients of group AY, and in 47.2% of group BY. The prevalence of PFO was 58.8% (95% confidence interval 43-62) in group AY and 28.8% in group BY (95% confidence interval 17-35) (chi(2) = 5.811; p = 0.01). A strong association was found between ASA and PFO. Of the 90 younger patients with stroke, 39 of 44 (88.6%) with ASA also had PFO, compared with 14 of 46 (30.4%) without ASA (chi(2) = 7.370; p = 0.007).
We found that ASA and PFO were independent predictive factors for stroke in younger patients with stroke and normal carotid arteries and that the association between ASA and PFO bore an increased odds risk.
多年来，房间隔瘤（ASA）一直被认为是心源性栓塞的潜在来源。意大利房间隔瘤多中心（ASA-MI）研究评估了中风且颈动脉正常的患者与无中风的对照患者中ASA的患病率和特征。本研究的目的是评估ASA-MI研究中纳入的年轻患者（年龄小于55岁）亚组中ASA的发生率及其与卵圆孔未闭（PFO）的关联。
ASA-MI研究纳入了1990年11月至1996年12月期间的606例患者：245例既往有脑栓塞发作且颈动脉检查正常的患者以及316例患者组成的对照组。他们均接受了经胸和经食管超声心动图检查。年龄小于55岁的年轻患者亚组包括90例患者（61例男性和29例女性，平均年龄49±5岁）（AY组）。对该组进行评估，并与年龄和性别匹配的对照人群（61例男性；平均年龄48±6岁）（BY组）进行比较。
AY组中ASA的患病率为48.8%（95%置信区间40-61），BY组为22.2%（95%置信区间18-33）（χ²=5.968；p=0.01）。两组患者的形态学特征相似。AY组52%的患者和BY组47.2%的患者ASA累及整个房间隔。AY组中PFO的患病率为58.8%（95%置信区间43-62），BY组为28.8%（95%置信区间17-35）（χ²=5.811；p=0.01）。发现ASA与PFO之间存在强关联。在90例年轻的中风患者中，44例有ASA的患者中有39例（88.6%）也有PFO，而46例无ASA的患者中有14例（30.4%）有PFO（χ²=7.370；p=0.007）。
我们发现，ASA和PFO是中风且颈动脉正常的年轻患者中风的独立预测因素，并且ASA与PFO之间存在增加的优势风险。
