Bayar Nermin, Arslan Şakir, Çağırcı Göksel, Erkal Zehra, Üreyen Çağın Mustafa, Çay Serkan, Köklü Erkan, Yüksel İsa Öner, Küçükseymen Selçuk
Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.
J Stroke Cerebrovasc Dis. 2015 Jun;24(6):1282-6. doi: 10.1016/j.jstrokecerebrovasdis.2015.01.036. Epub 2015 Apr 20.
The frequency of patent foramen ovale (PFO) is greater in patients who have had a stroke and transient ischemic attack (TIA) than that in the general population. However, it is not well defined, which PFO would cause stroke or TIA. In this trial, we aimed to evaluate whether there was a difference regarding morphologic features of PFO in patients who were symptomatic (cryptogenic stroke or history of TIA) or asymptomatic according to the neurologic findings.
Symptomatic patients with PFO and cryptogenic stroke or TIA and asymptomatic patients with PFO who were symptomatic in terms of neurologic findings as well as patients without any neurologic symptoms in whom PFO was diagnosed incidentally by transesophageal echocardiography were enrolled to this retrospective study on the condition that they were aged younger than 55 years. Not only the clinical and demographic characteristics of 2 groups were compared but also their morphological features were assessed. The morphologic features of PFO that were assessed included the length and height of tunnel, atrial septal excursion distance, thickness of septum primum, and thickness of septum secundum.
One hundred fifty-six patients, 64 of whom were symptomatic, were enrolled to this study. The height of PFO (median, 3.0 [interquartile range, 2.0-3.8]mm versus 2.0 [2.0-2.0]mm, P < .001), thickness of septum secundum (5.0 [5.0-7.0] versus 3.0 [2.0-3.0], P < .001), and septal excursion distance (7.0 [6.0-10.5] versus 4.0 [4.0-5.0], P < .001) were found to be greater in the symptomatic group than those in the asymptomatic group. There was no significant difference regarding the length of tunnel and thickness of septum primum. The ratio of length to height of PFO tunnel was less in the symptomatic group (3.0 [3.0-3.23] versus 5.0 [4.0-6.25], P < .001).
Our findings appear to indicate that a higher PFO tunnel, relatively greater interatrial septal mobility, thicker septum pellucidum, and the presence of an atrial septal aneurysm may help identifying the subjects at the age of or younger than 55 years with PFO who are at greater risk for cryptogenic stroke or TIA.
卵圆孔未闭（PFO）在中风和短暂性脑缺血发作（TIA）患者中的发生率高于普通人群。然而，哪种PFO会导致中风或TIA尚未明确界定。在本试验中，我们旨在评估根据神经学检查结果，有症状（隐匿性中风或TIA病史）或无症状的PFO患者在PFO形态特征方面是否存在差异。
本回顾性研究纳入了年龄小于55岁的有症状的PFO合并隐匿性中风或TIA患者、有神经学症状的无症状PFO患者以及经食管超声心动图偶然诊断出PFO且无任何神经学症状的患者。不仅比较了两组的临床和人口统计学特征，还评估了它们的形态特征。评估的PFO形态特征包括隧道的长度和高度、房间隔偏移距离、原发隔厚度和继发隔厚度。
156名患者纳入本研究，其中64名有症状。有症状组的PFO高度（中位数，3.0[四分位间距，2.0 - 3.8]mm对2.0[2.0 - 2.0]mm，P <.001）、继发隔厚度（5.0[5.0 - 7.0]对3.0[2.0 - 3.0]，P <.001）和隔偏移距离（7.0[6.0 - 10.5]对4.0[4.0 - 5.0]，P <.001）均高于无症状组。隧道长度和原发隔厚度无显著差异。有症状组的PFO隧道长宽比更低（3.0[3.0 - 3.23]对5.0[4.0 - 6.25]，P <.001）。
我们的研究结果似乎表明，较高的PFO隧道、相对较大的房间隔活动度、较厚的透明隔以及房间隔瘤的存在可能有助于识别年龄在55岁及以下患有PFO且发生隐匿性中风或TIA风险较高的患者。
