非心源性栓塞性卒中患者的心房解剖结构：药物治疗的效果

Atrial anatomy in non-cardioembolic stroke patients: effect of medical therapy.

作者信息

Homma Shunichi, Sacco Ralph L, Di Tullio Marco R, Sciacca Robert R, Mohr Jay P

机构信息

Department of Medicine, New York, New York 10032, USA.

出版信息

J Am Coll Cardiol. 2003 Sep 17;42(6):1066-72. doi: 10.1016/s0735-1097(03)00907-0.

DOI:10.1016/s0735-1097(03)00907-0

PMID:13678932

Abstract

OBJECTIVES

The purpose of the study was to assess the mechanism responsible for increased stroke risk in patients with atrial septal aneurysm (SA) and patent foramen ovale (PFO), and to determine the efficacy of medical therapy for preventing stroke recurrence or death.

BACKGROUND

Atrial septal aneurysm and PFO are associated with stroke. However, the mechanism for this association is undefined, and the efficacy of medical therapy has not been investigated in a randomized fashion.

METHODS

The Patent foramen ovale In Cryptogenic Stroke Study (PICSS) evaluated transesophageal echocardiography findings in patients enrolled in the Warfarin-Aspirin Recurrent Stroke Study, a randomized double-blind trial to evaluate the efficacy of warfarin compared with aspirin.

RESULTS

Large PFO and prominent eustachian valve (EV) or right atrial (RA) filamentous strands were found more frequently in patients with SA compared with those without SA (37.7% vs. 10.9%, p < 0.001 and 59.4% vs. 43.1%, p = 0.02). Patients with SA and PFO had no significant difference in time to recurrent stroke or death compared with those having neither (hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.49 to 2.38, p = 0.84; two-year event rates 15.9% vs. 14.5%). Patients with SA, PFO, and RA anatomy predisposing to paradoxical embolization also had no difference compared with those without these findings (HR 1.22, 95% CI 0.43 to 3.47, p = 0.71; two-year event rates 18.2% vs. 14.2%). There was no significant difference in time to recurrent stroke or death between the patients treated with warfarin or aspirin (HR 1.00, 95% CI 0.22 to 4.47, p = 1.0; two-year event rates 16.0% vs. 15.8%).

CONCLUSIONS

Atrial septal aneurysm is associated with the presence of large PFO and prominent EV or RA filamentous strands. On medical therapy, patients with SA and PFO did not experience increased risk of adverse events, and there was no difference between treatment results for warfarin and for aspirin.

摘要

目的

本研究旨在评估房间隔瘤（SA）和卵圆孔未闭（PFO）患者中风风险增加的机制，并确定药物治疗预防中风复发或死亡的疗效。

背景

房间隔瘤和卵圆孔未闭与中风有关。然而，这种关联的机制尚不清楚，且药物治疗的疗效尚未以随机方式进行研究。

方法

卵圆孔未闭在隐源性中风研究（PICSS）评估了参与华法林 - 阿司匹林复发性中风研究患者的经食管超声心动图检查结果，该研究是一项随机双盲试验，旨在评估华法林与阿司匹林的疗效。

结果

与无SA的患者相比，SA患者中发现大的卵圆孔未闭和显著的欧氏瓣（EV）或右心房（RA）丝状束的频率更高（37.7% 对10.9%，p < 0.001；59.4% 对43.1%，p = 0.02）。与既无SA也无PFO的患者相比，有SA和PFO的患者中风复发或死亡时间无显著差异（风险比[HR] 1.08，95% 置信区间[CI] 0.49至2.38，p = 0.84；两年事件发生率15.9% 对14.5%）。与无这些发现的患者相比，有SA、PFO和易发生反常栓塞的RA解剖结构的患者也无差异（HR 1.22，95% CI 0.43至3.47，p = 0.71；两年事件发生率18.2% 对14.2%）。接受华法林或阿司匹林治疗的患者中风复发或死亡时间无显著差异（HR 1.00，95% CI 0.22至4.47，p = 1.0；两年事件发生率16.0% 对15.8%）。