Serafini Oscar, Misuraca Gianfranco, Greco Francesco, Bisignani Giovanni, Manes Maria Teresa, Venneri Nicola
Divisione di Cardiologia, Azienda Ospedaliera dell'Annunziata, Cosenza.
Ital Heart J Suppl. 2003 Jan;4(1):39-45.
Ischemic stroke is one of the most frequent causes of morbidity and mortality in industrialized countries. In more than 40% of cases the cause of the ischemic event is not recognized, especially in young patients in whom, moreover, the presence of a structural abnormality of atrial septal aneurysm (ASA) and patent foramen ovale (PFO) is more frequently reported. The prevalence of this two minor atrial septal defects is strongly related to the study population (unselected patients and patients with recent ischemic stroke/transient ischemic attack-TIA) and to the diagnostic tool employed (transthoracic echocardiography--TTE or transesophageal echocardiography--TEE).
We retrospectively evaluated the prevalence of ASA in 16,836 patients who underwent TTE from January 1, 1994 to June 30, 2002. During this time period we also evaluated the prevalence of ASA, PFO and their association in 1795 patients in whom a TEE was performed. The patients who underwent TEE were divided into two groups: group A included 430 patients with recent stroke/TIA or suspect cardioembolic event, and group B included 1365 patients as controls.
An ASA was detected in 1.6% of the whole study population; 0.7% of the patients underwent TTE and 10.2% of the patients underwent TEE. In group A the prevalence of ASA was 24%, in group B 4.7% (p < 0.001). A PFO was identified in 9.9% of patients in whom a TEE was performed; the rate was 24% in group A and 5.3% in group B (p < 0.001). In a subgroup of 65 patients, < 60 years (mean age 45 +/- 8 years), with cryptogenic or unexplained stroke/TIA a TEE examination identified the presence of ASA, PFO and their association in a rate of 20, 15 and 34%, respectively.
Our data show, in a large study population, a prevalence of ASA and PFO not negligible. The association of this two atrial septal abnormalities in patients with stroke/TIA, especially those classified as cryptogenic, suggests to study in depth these minor atrial septal defects and in particular: 1) to standardize ASA definition; 2) to identify the etiopathogenetic mechanisms leading to embolic events; 3) to define the best pharmacological treatment.
在工业化国家，缺血性中风是发病和死亡的最常见原因之一。在超过40%的病例中，缺血事件的病因不明，尤其是在年轻患者中，此外，房间隔瘤（ASA）和卵圆孔未闭（PFO）结构异常的发生率更高。这两种较小的房间隔缺损的患病率与研究人群（未选择的患者和近期缺血性中风/短暂性脑缺血发作-TIA患者）以及所采用的诊断工具（经胸超声心动图-TTE或经食管超声心动图-TEE）密切相关。
我们回顾性评估了1994年1月1日至2002年6月30日期间接受TTE检查的16836例患者中ASA的患病率。在此期间，我们还评估了1795例接受TEE检查的患者中ASA、PFO的患病率及其相关性。接受TEE检查的患者分为两组：A组包括430例近期中风/TIA或疑似心源性栓塞事件的患者，B组包括1365例作为对照的患者。
在整个研究人群中，1.6%的患者检测到ASA；接受TTE检查的患者为0.7%，接受TEE检查的患者为10.2%。A组中ASA的患病率为24%，B组为4.7%（p<0.001）。在接受TEE检查的患者中，9.9%的患者发现有PFO；A组的发生率为24%，B组为5.3%（p<0.001）。在一个65例年龄<60岁（平均年龄45±8岁）的隐源性或不明原因中风/TIA患者亚组中，TEE检查发现ASA、PFO及其相关性的发生率分别为20%、15%和34%。
我们的数据显示，在一个大型研究人群中，ASA和PFO的患病率不可忽视。中风/TIA患者，尤其是那些被归类为隐源性的患者中，这两种房间隔异常的相关性表明需要深入研究这些较小的房间隔缺损，特别是：1）规范ASA的定义；2）确定导致栓塞事件的病因发病机制；3）确定最佳的药物治疗方法。
