Consoli Domenico, Paciaroni Maurizio, Galati Franco, Aguggia Marco, Melis Maurizio, Malferrari Giovanni, Consoli Arturo, Vidale Simone, Bosco Domenico, Cerrato Paolo, Sacco Simona, Gandolfo Carlo, Bovi Paolo, Serrati Carlo, Del Sette Massimo, Cavallini Anna, Diomedi Marina, Postorino Paolo, Reboldi Paolo, Ricci Stefano
UO Neurologia Ospedale 'G. Jazzolino', ViboValentia, Italy.
Cerebrovasc Dis. 2015;39(3-4):162-9. doi: 10.1159/000375152. Epub 2015 Feb 26.
Although several authors have studied the association between patent foramen ovale (PFO) and ischaemic stroke, the matter is still controversial; few have suggested an association between cryptogenetic stroke and PFO, while others have denied this association. The aim of this study was to evaluate PFO prevalence in the whole ischaemic stroke population, independently from age and stroke subtypes and to identify the characteristics associated with the presence of PFO.
SISIFO study was a multicenter, prospective, single-wave, cross-sectional survey conducted on consecutive patients with acute ischemic stroke admitted to selected clinical centres. Data regarding vascular risk factors were registered for each patient; all patients underwent computed tomography scan and/or magnetic resonance imaging of the brain; an electrocardiogram and standard laboratory blood tests were performed. A Doppler ultrasound study of extra-cranial arteries was performed too. The cases were classified according to TOAST and OCSP criteria. Each patient underwent transcranial Doppler or transcranial color-coded duplex sonography with bubble test as diagnostic tool for right-to-left-shunt. Where right-to-left shunt was detected, PFO presence was confirmed by echocardiography.
1,130 consecutive patients were included. We found a PFO in 247 (21.9%; 95% CI, 19.5-24.3%) patients; PFO was present in 23.5% of patients with cryptogenic stroke and in 21.3% of patients with stroke of known causes; this difference was not statistically significant. At the univariate analysis, decreasing age, hypertension, diabetes mellitus, and atrial fibrillation, and stroke characteristics such as NIHSS, OCSP and TOAST were predictors of PFO presence. At the multivariate analysis, we found a significant interaction between age and OCSP syndrome. Being LACI the reference category, the prevalence of PFO in PACI and POCI decreased significantly along with age, whereas there was no change in TACI.
If any relationship exists between stroke and PFO, this is more likely in PACI and POCI at a younger age. Our results are consistent with recent findings that underline PFO alone must not be considered a significant independent predictor for stroke; so the presence of PFO alone doesn't permit rushed causal correlations or 'therapeutic aggressiveness'.
尽管已有多位作者研究了卵圆孔未闭（PFO）与缺血性卒中之间的关联，但该问题仍存在争议；少数人认为隐源性卒中与PFO有关联，而其他人则否认这种关联。本研究的目的是评估整个缺血性卒中人群中PFO的患病率，不受年龄和卒中亚型的影响，并确定与PFO存在相关的特征。
SISIFO研究是一项多中心、前瞻性、单波横断面调查，对入选临床中心收治的急性缺血性卒中连续患者进行。记录每位患者的血管危险因素数据；所有患者均接受脑部计算机断层扫描和/或磁共振成像；进行心电图和标准实验室血液检查。还对颅外动脉进行了多普勒超声检查。病例根据TOAST和OCSP标准进行分类。每位患者接受经颅多普勒或经颅彩色编码双功超声检查，并进行气泡试验作为诊断右向左分流的工具。检测到右向左分流时，通过超声心动图确认PFO的存在。
纳入1130例连续患者。我们在247例（21.9%；95%CI，19.5 - 24.3%）患者中发现了PFO；在隐源性卒中患者中，PFO的存在率为23.5%，在已知病因的卒中患者中为21.3%；这种差异无统计学意义。单因素分析时，年龄降低、高血压、糖尿病、心房颤动以及卒中特征如美国国立卫生研究院卒中量表（NIHSS）、OCSP和TOAST是PFO存在的预测因素。多因素分析时，我们发现年龄与OCSP综合征之间存在显著交互作用。以腔隙性梗死（LACI）为参照类别，年龄增长时，部分前循环梗死（PACI）和后循环梗死（POCI）中PFO的患病率显著降低，而完全前循环梗死（TACI）中则无变化。
如果卒中与PFO之间存在任何关系，那么在年轻患者的PACI和POCI中这种关系更有可能存在。我们的结果与最近的研究结果一致，即强调不能仅将PFO视为卒中的重要独立预测因素；因此，仅PFO的存在不能仓促建立因果关联或采取“激进治疗”。
