Department of Medicine, Columbia University, New York, NY, USA.
J Am Coll Cardiol. 2013 Jul 2;62(1):35-41. doi: 10.1016/j.jacc.2013.03.064. Epub 2013 May 1.
The purpose of this study was to evaluate the relationship between patent foramen ovale (PFO), ischemic stroke, and subclinical cerebrovascular disease in the general population.
PFO is found more frequently in stroke patients than in stroke-free controls. However, the PFO-related stroke risk in the general population is not well established, and the relationship between PFO and silent brain infarcts (SBI) is not known.
PFO presence was assessed by transthoracic echocardiography with saline contrast injection in 1,100 stroke-free individuals over age 39 of a community-based sample followed for a mean of 11 years. In addition, 360 participants underwent brain magnetic resonance imaging (MRI) for SBI detection. We evaluated the risk of stroke associated with PFO after adjusting for established stroke risk factors and examined the odds of having SBI among those with and without PFO.
PFO was present in 164 participants (14.9%). Over a mean follow-up of 11.0 ± 4.5 years, 111 ischemic strokes occurred (10.1%), 15 (9.2%) in the PFO+ and 96 (10.3%) in the PFO- groups. The 12.5-year cumulative risk of stroke was 10.1% (standard error: 2.5%) in the PFO+ and 10.4% (standard error: 1.1%) in the PFO- group (p = 0.46). The adjusted hazard ratio for PFO and stroke was 1.10 (95% confidence interval [CI]: 0.64 to 1.91). In the MRI subcohort, PFO was not associated with SBI (adjusted odds ratio: 1.15, 95% CI: 0.50 to 2.62).
In this community-based cohort, PFO was not associated with an increased risk of clinical stroke or subclinical cerebrovascular disease.
本研究旨在评估卵圆孔未闭（PFO）、缺血性卒中以及普通人群亚临床脑血管疾病之间的关系。
PFO 在卒中患者中比在无卒中对照组中更为常见。然而，普通人群中 PFO 相关卒中风险尚不清楚，PFO 与无症状性脑梗死（SBI）之间的关系也不清楚。
在一个基于社区的样本中，我们对 1100 名年龄在 39 岁以上且无卒中的个体进行经胸超声心动图检查，并通过盐水对比注射评估 PFO 存在情况，这些个体的中位随访时间为 11 年。此外，360 名参与者接受了脑磁共振成像（MRI）检查以检测 SBI。我们在调整了已确立的卒中危险因素后评估了 PFO 相关卒中风险，并检查了有和无 PFO 个体中 SBI 的发生几率。
164 名参与者（14.9%）存在 PFO。在平均 11.0±4.5 年的随访期间，发生了 111 例缺血性卒中（10.1%），其中 PFO+组 15 例（9.2%），PFO-组 96 例（10.3%）。PFO+组和 PFO-组 12.5 年累积卒中风险分别为 10.1%（标准误：2.5%）和 10.4%（标准误：1.1%）（p=0.46）。PFO 与卒中的调整后危险比为 1.10（95%可信区间[CI]：0.64 至 1.91）。在 MRI 亚组中，PFO 与 SBI 无关（调整后比值比：1.15，95% CI：0.50 至 2.62）。
在本基于社区的队列中，PFO 与临床卒中或亚临床脑血管疾病的风险增加无关。
