老年患者的卵圆孔未闭与不明原因卒中

Patent foramen ovale and cryptogenic stroke in older patients.

作者信息

Handke Michael, Harloff Andreas, Olschewski Manfred, Hetzel Andreas, Geibel Annette

机构信息

Department of Cardiology, University Hospital Freiburg, Freiburg, Germany.

出版信息

N Engl J Med. 2007 Nov 29;357(22):2262-8. doi: 10.1056/NEJMoa071422.

DOI:10.1056/NEJMoa071422

PMID:18046029

Abstract

BACKGROUND

Studies to date have shown an association between the presence of patent foramen ovale and cryptogenic stroke in patients younger than 55 years of age. This association has not been established in patients 55 years of age or older.

METHODS

We prospectively examined 503 consecutive patients who had had a stroke, and we compared the 227 patients with cryptogenic stroke and the 276 control patients with stroke of known cause. We examined the prevalences of patent foramen ovale and of patent foramen ovale with concomitant atrial septal aneurysm in all patients, using transesophageal echocardiography. We also compared data for the 131 younger patients (< 55 years of age) and those for the 372 older patients (> or = 55 years of age).

RESULTS

The prevalence of patent foramen ovale was significantly greater among patients with cryptogenic stroke than among those with stroke of known cause, for both younger patients (43.9% vs. 14.3%; odds ratio, 4.70; 95% confidence interval [CI], 1.89 to 11.68; P<0.001) and older patients (28.3% vs. 11.9%; odds ratio, 2.92; 95% CI, 1.70 to 5.01; P<0.001). Even stronger was the association between the presence of patent foramen ovale with concomitant atrial septal aneurysm and cryptogenic stroke, as compared with stroke of known cause, among both younger patients (13.4% vs. 2.0%; odds ratio, 7.36; 95% CI, 1.01 to 326.60; P=0.049) and older patients (15.2% vs. 4.4%; odds ratio, 3.88; 95% CI, 1.78 to 8.46; P<0.001). Multivariate analysis adjusted for age, plaque thickness, and presence or absence of coronary artery disease and hypertension showed that the presence of patent foramen ovale was independently associated with cryptogenic stroke in both the younger group (odds ratio, 3.70; 95% CI, 1.42 to 9.65; P=0.008) and the older group (odds ratio, 3.00; 95% CI, 1.73 to 5.23; P<0.001).

CONCLUSIONS

There is an association between the presence of patent foramen ovale and cryptogenic stroke in both older patients and younger patients. These data suggest that paradoxical embolism is a cause of stroke in both age groups.

摘要

背景

迄今为止的研究表明，在55岁以下的患者中，卵圆孔未闭与不明原因卒中之间存在关联。在55岁及以上的患者中，这种关联尚未得到证实。

方法

我们对503例连续发生卒中的患者进行了前瞻性研究，并比较了227例不明原因卒中患者和276例已知病因卒中的对照患者。我们使用经食管超声心动图检查了所有患者中卵圆孔未闭以及合并房间隔瘤的卵圆孔未闭的患病率。我们还比较了131例年轻患者（<55岁）和372例老年患者（≥55岁）的数据。

结果

在不明原因卒中患者中，卵圆孔未闭的患病率显著高于已知病因卒中的患者，年轻患者（43.9%对14.3%；优势比，4.70；95%置信区间[CI]，1.89至11.68；P<0.001）和老年患者（28.3%对11.9%；优势比，2.92；95%CI，1.70至5.01；P<0.001）均如此。与已知病因卒中相比，合并房间隔瘤的卵圆孔未闭与不明原因卒中之间的关联在年轻患者（13.4%对2.0%；优势比，7.36；95%CI，1.01至326.60；P=0.049）和老年患者（15.2%对4.4%；优势比，3.88；95%CI，1.78至8.46；P<0.001）中甚至更强。对年龄、斑块厚度以及是否存在冠状动脉疾病和高血压进行多变量分析显示，卵圆孔未闭的存在在年轻组（优势比，3.70；95%CI，1.42至9.65；P=0.008）和老年组（优势比，3.00；95%CI，1.73至5.23；P<0.001）中均与不明原因卒中独立相关。