Giardini Alessandro, Donti Andrea, Formigari Roberto, Salomone Luisa, Palareti Gualtiero, Guidetti Donata, Picchio Fernando Maria
Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy.
Int J Cardiol. 2007 Sep 3;120(3):357-62. doi: 10.1016/j.ijcard.2006.10.012. Epub 2006 Dec 12.
We sought to determine whether migraine headache with aura (MHA) and spontaneous large right-to-left (R-L) shunt are risk factors for recurrent cerebral ischemic events in cryptogenic stroke patients with a patent foramen ovale (PFO).
140 patients with a PFO and cryptogenic stroke underwent transcatheter defect closure at our institution at a mean age of 45+/-13 years. We retrospectively analyzed follow-up data from the first cerebral ischemic event to the time of PFO closure. Before the procedure, all patients underwent transesophageal echocardiography (TEE); Transcranial Doppler scanning (TCD) was additionally performed on the last 59 patients. We analyzed the impact of MHA, thrombophilia, spontaneous large R-L shunt, and atrial septal aneurysm (ASA) on the risk of recurrent cerebral ischemic events.
44 patients (31%) had had at least 1 recurrent event during a follow-up of 2.2+/-2.6 years. Patients with recurrent events were more commonly females (p=0.0001), had more often an associated thrombophilia (p=0.0077), and had a higher prevalence of spontaneously large R-L shunt both at TEE and at TCD (p<0.05). They also had more commonly a history of MHA (p=0.0009) and more frequent episodes of MHA (p=0.0048). Patients with MHA had a higher risk of recurrent events when compared to patients without (odds ratio 3.87, 95% CI 1.75 to 8.50). Thrombophilia (p=0.001) and spontaneous large R-L shunt (p=0.02) were independent predictors of recurrent stroke.
In cryptogenic stroke patients with a PFO, a history of MHA, large spontaneous large R-L shunt, and thrombophilia are all associated with a higher risk of recurrent events.
我们试图确定伴先兆偏头痛（MHA）和自发性大量右向左（R-L）分流是否为卵圆孔未闭（PFO）的隐源性卒中患者复发性脑缺血事件的危险因素。
140例患有PFO和隐源性卒中的患者在我们机构接受了经导管缺损封堵术，平均年龄为45±13岁。我们回顾性分析了从首次脑缺血事件到PFO封堵时的随访数据。术前，所有患者均接受了经食管超声心动图（TEE）检查；另外对最后59例患者进行了经颅多普勒扫描（TCD）。我们分析了MHA、易栓症、自发性大量R-L分流和房间隔瘤（ASA）对复发性脑缺血事件风险的影响。
在2.2±2.6年的随访期间，44例患者（31%）至少发生过1次复发事件。复发事件患者中女性更为常见（p = 0.0001），更常伴有易栓症（p = 0.0077），并且在TEE和TCD检查中自发性大量R-L分流的患病率更高（p < 0.05）。他们也更常伴有MHA病史（p = 0.0009）和更频繁的MHA发作（p = 0.0048）。与无MHA的患者相比，有MHA的患者复发事件的风险更高（比值比3.87，95%可信区间1.75至8.50）。易栓症（p = 0.001）和自发性大量R-L分流（p = 0.02）是复发性卒中的独立预测因素。
在患有PFO的隐源性卒中患者中，MHA病史、大量自发性R-L分流和易栓症均与更高的复发事件风险相关。
