Ponamgi Shiva P, Vaidya Vaibhav R, Desimone Christopher V, Noheria Amit, Hodge David O, Slusser Joshua P, Ammash Naser M, Bruce Charles J, Rabinstein Alejandro A, Friedman Paul A, Asirvatham Samuel J
Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Pacing Clin Electrophysiol. 2017 Mar;40(3):310-322. doi: 10.1111/pace.12985. Epub 2017 Feb 7.
Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO.
In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram.
Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447-2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95% CI 1.593-2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95% CI 1.351-1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up.
In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.
经超声心动图检测发现，心脏植入式电子设备（CIED）患者的卵圆孔未闭（PFO）与中风/短暂性脑缺血发作（TIA）有关。我们试图评估CIED合并PFO患者的超声心动图特征与中风/TIA风险及死亡率之间的关系。
在6086例植入设备的患者中，319例检测到PFO。250例患者有基线超声心动图，其中186例进行了随访超声心动图检查。
在250例有基线超声心动图的患者中，平均随访5.3±3.1年期间，9.6%（n=24）发生中风/TIA；7.1±3.7年期间，42%（n=105）死亡。房间隔瘤、显著的欧氏瓣、PFO处可见分流、基线或估计右心室收缩压（RVSP）/三尖瓣反流（TR）变化或最大RVSP与植入后中风/TIA无关（P>0.05）。使用时间依赖性Cox模型进行的探索性多变量分析显示，TR增加≥2级的患者死亡风险增加（风险比[HR]1.780，95%置信区间[CI]1.447-2.189，P<0.0001），或RVSP增加>10 mmHg（HR 2.018，95%CI 1.593-2.556，P<0.0001），或随访时最大RVSP（HR 1.432，95%CI 1.351-1.516，P<0.0001）。随访期间还发现TR显著增加（P<0.001）。
在CIED合并PFO的患者中，超声心动图的结构和血流动力学指标不能预测未来的中风/TIA。然而，TR或RVSP显著升高与较高的死亡率相关。
