复发性中风的预测因素在接受药物治疗的致病性卵圆孔未闭与其他卵圆孔未闭患者中有所不同。
Recurrent stroke predictors differ in medically treated patients with pathogenic vs. other PFOs.
作者信息
Thaler David E, Ruthazer Robin, Weimar Christian, Mas Jean-Louis, Serena Joaquín, Di Angelantonio Emanuele, Papetti Federica, Homma Shunichi, Mattle Heinrich P, Nedeltchev Krassen, Mono Marie-Luise, Jaigobin Cheryl, Michel Patrik, Elkind Mitchell S V, Di Tullio Marco R, Lutz Jennifer S, Griffith John, Kent David M
机构信息
From the Department of Neurology (D.E.T., D.M.K.) and the Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies (R.R., J.S.L., J.G., D.M.K.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA; the University of Duisburg-Essen (C.W.), Germany; Hôpital Sainte-Anne (J.L.-M.), Paris-Descartes University, France; the Department of Neurology (J.S.), Hospital Universitari Doctor Josep Trueta Institut d'Investigació Biomèdica de Girona, Spain; the Department of Public Health and Primary Care (E.D.A.), Cambridge University, UK; the Department of Cardiology (F.P.), Sapienza University of Rome, Italy; the Departments of Cardiology (S.H.) and Neurology and Epidemiology (M.S.V.E.) and the Division of Cardiology (M.R.D.T.), Columbia University, New York; Inselspital (H.P.M., M.-L.M.), University of Bern; the Division of Neurology (K.N.), Triemli Municipal Hospital, Zurich, Switzerland; the University of Toronto (C.J.), Canada; and Centre Hospitalier Universitaire Vaudois (P.M.), Switzerland.
出版信息
Neurology. 2014 Jul 15;83(3):221-6. doi: 10.1212/WNL.0000000000000589. Epub 2014 Jun 13.
OBJECTIVE
To examine predictors of stroke recurrence in patients with a high vs a low likelihood of having an incidental patent foramen ovale (PFO) as defined by the Risk of Paradoxical Embolism (RoPE) score.
METHODS
Patients in the RoPE database with cryptogenic stroke (CS) and PFO were classified as having a probable PFO-related stroke (RoPE score of >6, n = 647) and others (RoPE score of ≤6 points, n = 677). We tested 15 clinical, 5 radiologic, and 3 echocardiographic variables for associations with stroke recurrence using Cox survival models with component database as a stratification factor. An interaction with RoPE score was checked for the variables that were significant.
RESULTS
Follow-up was available for 92%, 79%, and 57% at 1, 2, and 3 years. Overall, a higher recurrence risk was associated with an index TIA. For all other predictors, effects were significantly different in the 2 RoPE score categories. For the low RoPE score group, but not the high RoPE score group, older age and antiplatelet (vs warfarin) treatment predicted recurrence. Conversely, echocardiographic features (septal hypermobility and a small shunt) and a prior (clinical) stroke/TIA were significant predictors in the high but not low RoPE score group.
CONCLUSION
Predictors of recurrence differ when PFO relatedness is classified by the RoPE score, suggesting that patients with CS and PFO form a heterogeneous group with different stroke mechanisms. Echocardiographic features were only associated with recurrence in the high RoPE score group.
目的
根据反常栓塞风险（RoPE）评分，研究偶然发现卵圆孔未闭（PFO）可能性高与低的患者中风复发的预测因素。
方法
将RoPE数据库中患有隐源性卒中（CS）和PFO的患者分为可能与PFO相关的卒中（RoPE评分>6，n = 647）和其他患者（RoPE评分≤6分，n = 677）。我们使用Cox生存模型，以成分数据库作为分层因素，测试了15个临床变量、5个放射学变量和3个超声心动图变量与中风复发的相关性。对有显著意义的变量检查其与RoPE评分的交互作用。
结果
1年、2年和3年的随访率分别为92%、79%和57%。总体而言，首发短暂性脑缺血发作（TIA）与较高的复发风险相关。对于所有其他预测因素，在两个RoPE评分类别中的影响存在显著差异。对于RoPE评分低的组（而非RoPE评分高的组），年龄较大和抗血小板治疗（与华法林相比）可预测复发。相反，超声心动图特征（房间隔活动度增加和小分流）和既往（临床）卒中/TIA在RoPE评分高的组中是显著的预测因素，而在RoPE评分低的组中不是。
结论
当根据RoPE评分对PFO相关性进行分类时，复发的预测因素不同，这表明患有CS和PFO的患者构成了一个具有不同中风机制的异质性群体。超声心动图特征仅与RoPE评分高的组中的复发相关。
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