Department of Neurology, Justus Liebig University Giessen, Am Steg 14, Giessen, 35392, Germany.
BMC Cardiovasc Disord. 2011 Aug 26;11:54. doi: 10.1186/1471-2261-11-54.
As previously reported there is evidence for a reduction in right to left shunt (RLS) in stroke patients with patent foramen ovale (PFO). This occurs predominantly in patients with cryptogenic stroke (CS). We therefore analysed factors associated with a shunt reduction on follow-up in stroke patients suffering of CS.
On index event PFO and RLS were proven by transesophageal echocardiography and contrast-enhanced transcranial Doppler-sonography (ce-TCD). Silent PE was proved by ventilation perfusion scintigraphy (V/Q) within the stroke work-up on index event; all scans were re-evaluated in a blinded manner by two experts. The RLS was re-assessed on follow-up by ce-TCD. A reduction in shunt volume was defined as a difference of ≥20 microembolic signals (MES) or the lack of evidence of RLS on follow-up. For subsequent analyses patients with CS were considered; parameters such as deep vein thrombosis (DVT) and silent pulmonary embolism (PE) were analysed.
In 39 PFO patients suffering of a CS the RLS was re-assessed on follow-up. In all patients (n = 39) with CS a V/Q was performed; the median age was 40 years, 24 (61.5%) patients were female. In 27 patients a reduction in RLS was evident. Silent PE was evident in 18/39 patients (46.2%). Factors such as atrial septum aneurysm, DVT or even silent PE were not associated with RLS dynamics. A greater time delay from index event to follow-up assessment was associated with a decrease in shunt volume (median 12 vs. 6 months, p = 0.013).
In patients with CS a reduction in RLS is not associated with the presence of a venous embolic event such as DVT or silent PE. A greater time delay between the initial and the follow-up investigation increases the likelihood for the detection of a reduction in RLS.
先前的研究表明，卵圆孔未闭（PFO）的中风患者右向左分流（RLS）减少。这种情况主要发生在隐源性中风（CS）患者中。因此，我们分析了 CS 中风患者随时间推移分流减少的相关因素。
在指数事件中，通过经食管超声心动图和对比增强经颅多普勒超声（ce-TCD）证实 PFO 和 RLS。在指数事件的中风检查中通过通气灌注闪烁扫描（V/Q）证实无症状性肺栓塞（PE）；所有扫描均由两位专家以盲法进行重新评估。通过 ce-TCD 在随访中重新评估 RLS。分流体积减少定义为差异≥20 个微栓子信号（MES）或随访时缺乏 RLS 证据。为了进行后续分析，考虑了 CS 患者；分析了深静脉血栓形成（DVT）和无症状性 PE 等参数。
在 39 例 CS 患者中，对 RLS 进行了随访评估。所有 CS 患者（n=39）均进行了 V/Q 检查；中位年龄为 40 岁，24 例（61.5%）为女性。27 例患者 RLS 明显减少。39 例患者中有 18 例（46.2%）存在无症状性 PE。房间隔瘤、DVT 甚至无症状性 PE 等因素与 RLS 动力学无关。从指数事件到随访评估的时间间隔较长与分流体积减少相关（中位数为 12 个月比 6 个月，p=0.013）。
在 CS 患者中，RLS 减少与 DVT 或无症状性 PE 等静脉栓塞事件无关。初始和随访调查之间的时间间隔越长，检测到 RLS 减少的可能性越大。
