Katsanos Aristeidis H, Spence J David, Bogiatzi Chrysi, Parissis John, Giannopoulos Sotirios, Frogoudaki Alexandra, Safouris Apostolos, Voumvourakis Konstantinos, Tsivgoulis Georgios
From the Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece (A.H.K., S.G.); Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada (J.D.S., C.B.); Second Department of Cardiology (J.P., A.F.) and Second Department of Neurology (K.V., G.T.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; Stroke Unit, Department of Neurology, Brugmann University Hospital, Brussels, Belgium (A.S.); and Department of Neurology, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic (G.T.).
Stroke. 2014 Nov;45(11):3352-9. doi: 10.1161/STROKEAHA.114.007109. Epub 2014 Oct 7.
Recurrent cerebrovascular events are frequent in medically treated patients with patent foramen ovale (PFO), but it still remains unclear whether PFO is a causal or an incidental finding. Further uncertainty exists on whether the size of functional shunting could represent a potential risk factor. The aim of the present study was to evaluate if the presence of PFO is associated with an increased risk of recurrent stroke or transient ischemic attack and to investigate further if this relationship is related to the shunt size.
We conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of all available prospective studies reporting recurrent cerebrovascular events defined as cryptogenic stroke and transient ischemic attacks in medically treated patients with PFO diagnosed by echocardiography or transcranial sonography.
We identified 14 eligible studies including a total of 4251 patients. Patients with stroke with PFO did not have a higher risk of the combined outcome of recurrent stroke/transient ischemic attack (risk ratio=1.18; 95% confidence interval=0.78-1.79; P=0.43) or in the incidence of recurrent strokes (risk ratio =0.85; 95% confidence interval=0.59-1.22; P=0.37) in comparison with stroke patients without PFO. In addition, PFO size was not associated with the risk of recurrent stroke or transient ischemic attack. We also documented no evidence of heterogeneity across the included studies.
Our findings indicate that medically treated patients with PFO do not have a higher risk for recurrent cryptogenic cerebrovascular events, compared with those without PFO. No relation between the degree of PFO and the risk of future cerebrovascular events was identified.
在接受药物治疗的卵圆孔未闭（PFO）患者中，复发性脑血管事件很常见，但PFO是病因性还是偶发性发现仍不清楚。关于功能性分流的大小是否可能是一个潜在危险因素，还存在进一步的不确定性。本研究的目的是评估PFO的存在是否与复发性中风或短暂性脑缺血发作风险增加相关，并进一步研究这种关系是否与分流大小有关。
我们根据系统评价和Meta分析的首选报告项目（PRISMA）指南，对所有可用的前瞻性研究进行了系统评价和Meta分析，这些研究报告了经超声心动图或经颅超声诊断为PFO的接受药物治疗的患者中，复发性脑血管事件（定义为隐源性中风和短暂性脑缺血发作）的情况。
我们确定了14项符合条件的研究，共纳入4251例患者。与无PFO的中风患者相比，有PFO的中风患者发生复发性中风/短暂性脑缺血发作联合结局的风险（风险比=1.18；95%置信区间=0.78-1.79；P=0.43）或复发性中风的发生率（风险比=0.85；95%置信区间=0.59-1.22；P=0.37）并无更高。此外，PFO大小与复发性中风或短暂性脑缺血发作的风险无关。我们还记录到纳入研究之间没有异质性的证据。
我们的研究结果表明，与无PFO的患者相比，接受药物治疗的PFO患者发生复发性隐源性脑血管事件的风险并不更高。未发现PFO程度与未来脑血管事件风险之间存在关联。
Zotero 插件