Goliszek Sylwia, Wiśniewska Małgorzata, Kurnicka Katarzyna, Lichodziejewska Barbara, Ciurzyński Michał, Kostrubiec Maciej, Gołębiowski Marek, Babiuch Marek, Paczynska Marzanna, Koć Marcin, Palczewski Piotr, Wyzgał Anna, Pruszczyk Piotr
Dept. of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
Dept. of Radiology, Medical University of Warsaw, Poland.
Thromb Res. 2014 Nov;134(5):1052-6. doi: 10.1016/j.thromres.2014.09.013. Epub 2014 Sep 21.
Patent foramen ovale (PFO) is an established risk factor for ischemic stroke. Since acute right ventricular dysfunction (RVD) observed in patients with PE can lead to right-to-left inter-atrial shunt via PFO, we hypothesized that PFO is a risk factor for ischemic stroke in PE with significant right ventricular dysfunction.
55 patients (31 F, 24M), median age 49 years (range 19-83 years) with confirmed PE underwent echocardiography for RVD and PFO assessment. High risk acute PE was diagnosed in 3 (5.5%) patients, while 16 (29%) hemodynamically stable with RVD patients formed a group with intermediate-risk PE. PFO was diagnosed in 19 patients (34.5%). Diffusion-weighted MRI of the brain for acute ischemic stroke (AIS) was performed in all patients 4.91 ± 4.1 days after admission.
AIS was detected by MRI in 4 patients (7.3%). Only one stroke was clinically overt and resulted in hemiplegia. All 4 AIS occurred in the PFO positive group (4 of 19 patients), and none in subjects without PFO (21.0% vs 0%, p=0.02). Moreover, all AIS occurred in patients with RVD and PFO, and none in patients with PFO without RVD (50% vs 0%, p=0.038).
Our data suggest that acute pulmonary embolism resulting in right ventricular dysfunction may lead to acute ischemic stroke in patients with patent foramen ovale. However, the clinical significance of such lesions remains to be determined.
卵圆孔未闭（PFO）是缺血性卒中的一个既定危险因素。由于在肺栓塞（PE）患者中观察到的急性右心室功能障碍（RVD）可导致通过PFO的右向左心房分流，我们推测PFO是伴有严重右心室功能障碍的PE患者发生缺血性卒中的危险因素。
55例确诊为PE的患者（31例女性，24例男性），中位年龄49岁（范围19 - 83岁），接受了超声心动图检查以评估RVD和PFO。3例（5.5%）患者被诊断为高危急性PE，而16例（29%）血流动力学稳定且有RVD的患者形成了中危PE组。19例患者（34.5%）被诊断为PFO。所有患者在入院后4.91±4.1天接受了脑部急性缺血性卒中（AIS）的弥散加权MRI检查。
MRI检测到4例（7.3%）患者发生AIS。只有1例卒中在临床上明显并导致偏瘫。所有4例AIS均发生在PFO阳性组（19例患者中的4例），而无PFO的受试者中无一例发生（21.0%对0%，p = 0.02）。此外，所有AIS均发生在有RVD和PFO的患者中，而无RVD的PFO患者中无一例发生（50%对0%，p = 0.038）。
我们的数据表明，导致右心室功能障碍的急性肺栓塞可能会在卵圆孔未闭的患者中导致急性缺血性卒中。然而，此类病变的临床意义仍有待确定。
