Department of Cardiology, Pasteur University Hospital, Nice, France.
Department of Cardiology, Pasteur University Hospital, Nice, France.
Chest. 2014 Oct;146(4):967-973. doi: 10.1378/chest.14-0100.
Patent foramen ovale (PFO) in pulmonary embolism (PE) is associated with an increased risk of complications. However, little is known about PFO and ischemic stroke prevalence, particularly in acute intermediate-risk PE. In addition, in this context, the so-called "gold standard" method of PFO diagnosis remains unknown. We aimed to evaluate PFO and ischemic stroke prevalence and determine which of transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) is the best PFO diagnostic method in this context.
We conducted a prospective monocentric study of consecutive patients with intermediate-risk PE in whom a TEE and TTE with contrast were performed. Brain MRI was used to confirm clinically obvious strokes or to diagnose subclinical ones.
Forty-one patients with intermediate-risk PE were identified over a 9-month period. Contrast TEE revealed PFO in 56.1%, whereas contrast TTE showed PFO in only 19.5% (P < .001). Of note, all PFOs observed with TTE were also diagnosed by TEE. Ischemic stroke occurred in 17.1% and was always associated with PFO and large shunt.
PFO and related ischemic strokes are frequent in intermediate-risk PE. TEE is much more efficient than TTE for PFO diagnosis. Considering the high risk of intracranial bleeding with thrombolysis in PE, which may be partly due to hemorrhagic transformation of subclinical strokes, screening PFO with TEE should be considered in intermediate-risk PE when thrombolytic treatment is discussed.
卵圆孔未闭（PFO）与肺栓塞（PE）相关，与并发症风险增加相关。然而，对于 PFO 和缺血性中风的患病率，尤其是在急性中度风险 PE 中，我们知之甚少。此外，在这种情况下，所谓的 PFO 诊断“金标准”方法仍然未知。我们旨在评估 PFO 和缺血性中风的患病率，并确定在这种情况下经食管超声心动图（TEE）或经胸超声心动图（TTE）哪种是最佳的 PFO 诊断方法。
我们对 9 个月期间连续患有中度风险 PE 的患者进行了前瞻性单中心研究，对这些患者进行了 TEE 和对比 TTE。脑部 MRI 用于确认临床明显的中风或诊断亚临床中风。
在 9 个月期间确定了 41 例患有中度风险 PE 的患者。对比 TEE 显示 PFO 发生率为 56.1%，而对比 TTE 仅显示 PFO 发生率为 19.5%（P <.001）。值得注意的是，TTE 检测到的所有 PFO 也都通过 TEE 诊断。缺血性中风发生率为 17.1%，始终与 PFO 和大分流相关。
PFO 和相关的缺血性中风在中度风险 PE 中很常见。TEE 比 TTE 更有效地用于 PFO 诊断。考虑到溶栓治疗在 PE 中可能导致颅内出血的风险较高，部分原因可能是亚临床中风的出血性转化，因此在讨论溶栓治疗时，应考虑在中度风险 PE 中使用 TEE 筛查 PFO。
