Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, China.
Am J Cardiol. 2011 Dec 15;108(12):1815-9. doi: 10.1016/j.amjcard.2011.07.058. Epub 2011 Sep 1.
Studies have shown an association between the presence of a patent foramen ovale (PFO) and cryptogenic stroke (CS) in patients aged <55 years. In addition, protruding atheromatous plaques in the ascending aorta and aortic arch are an independent risk factor for ischemic stroke in patients aged ≥55 years. The aim of this study was to determine the association of CS in the 2 age groups with PFO and with atheromatous plaques in the ascending aorta and in the aortic arch. Transesophageal echocardiograms in 229 patients evaluated for CS were compared to those in 314 patients evaluated for cardiac disease other than PFO with no histories of stroke (the control group). The prevalence of PFO and the presence of complex atheromatous plaques in the ascending aorta and aortic arch were determined in all patients and compared between the CS and control patients in the 2 age groups. The prevalence of PFO was significantly higher in patients with CS than in control patients among those aged <55 years (31 of 114 [27%] vs 24 of 171 [14%], p = 0.006) and those aged ≥55 years (28 of 115 [24%] vs 21 of 143 [15%], p = 0.049). The incidence of atrial septal aneurysm was similar in the 2 groups irrespective of patient age, as was the prevalence of complex atheromatous plaques. Multivariate analysis showed that PFO was independently associated with CS, irrespective of patient age (<55 years: odds ratio 2.4, 95% confidence interval 1.3 to 4.5, p = 0.01; ≥55 years: odds ratio 1.9, 95% confidence interval 1.1 to 3.5, p = 0.03). In conclusion, PFO was significantly associated with CS in younger (aged <55 years) and older (aged ≥55 years) patients. Atrial septal aneurysm and complex atheromas in the ascending aorta and aortic arch do not appear to be associated with CS.
研究表明，在年龄<55 岁的患者中，卵圆孔未闭（PFO）的存在与隐源性中风（CS）之间存在关联。此外，升主动脉和主动脉弓突出的粥样硬化斑块是年龄≥55 岁的患者发生缺血性中风的独立危险因素。本研究旨在确定这两个年龄组的 CS 与 PFO 以及升主动脉和主动脉弓粥样硬化斑块之间的关联。对 229 例因 CS 而接受评估的患者进行经食管超声心动图检查，并与 314 例因非 PFO 心脏病而无中风史（对照组）的患者进行比较。在所有患者中确定 PFO 的患病率以及升主动脉和主动脉弓复杂粥样硬化斑块的存在，并在这两个年龄组的 CS 患者和对照组患者之间进行比较。在年龄<55 岁的 CS 患者中，PFO 的患病率明显高于对照组患者（31/114 [27%] 比 24/171 [14%]，p=0.006），年龄≥55 岁的 CS 患者中，PFO 的患病率也明显高于对照组患者（28/115 [24%] 比 21/143 [15%]，p=0.049）。两组患者不论年龄大小，房间隔瘤的发生率相似，复杂粥样硬化斑块的患病率也相似。多变量分析显示，PFO 与 CS 独立相关，与患者年龄无关（<55 岁：比值比 2.4，95%置信区间 1.3 至 4.5，p=0.01；≥55 岁：比值比 1.9，95%置信区间 1.1 至 3.5，p=0.03）。总之，PFO 与年龄较小（<55 岁）和年龄较大（≥55 岁）的患者的 CS 明显相关。房间隔瘤和升主动脉及主动脉弓的复杂粥样斑块似乎与 CS 无关。
