Lantz Maria, Kostulas Konstantinos, Settergren Magnus, Sjöstrand Christina
Department of Clinical Neuroscience Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
J Interv Cardiol. 2017 Jun;30(3):242-248. doi: 10.1111/joic.12383. Epub 2017 Apr 25.
Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS) and migraine with aura (MA). Endothelial dysfunction (ED) is a risk factor for development of cardiovascular disease, but might also be involved in migraine pathophysiology. Short-term worsening of migraine has been described after closure of PFO. We evaluated endothelial function in patients with CS and PFO, before and after closure of PFO, and in patients with migraine, whether changes in endothelial function was related to a change in migraine frequency.
Patients with CS and PFO were included; 20 with planned closure of PFO and seven controls on medical treatment only. Endothelial function was assessed by peripheral arterial tonometry (EndoPat ) and biomarkers of endothelial activation. Patients were followed longitudinally at baseline, day 1, 1 month, and 6 months. A headache diary was used to assess migraine frequency.
Mean age of the cohort was 45.4 years, and migraine prevalence was 50% whereof 84.6% had MA. Median EndoPat index (RHI) at baseline was 1.60 (IQR 1.41-2.00). There was no change in RHI over time, either in closure patients (P = 0.66), nor in controls (P = 0.31), and there was no change in biomarkers of endothelial activation. Three migraine patients experienced worsening of migraine frequency directly after closure.
Endothelial function did not change after closure of PFO. Although patients were lacking cardiovascular risk factors, a high proportion had impaired endothelial function. Whether ED can have predictive value, identifying PFO at higher risk for recurrent stroke warrants further investigations.
卵圆孔未闭（PFO）与不明原因卒中（CS）和伴先兆偏头痛（MA）相关。内皮功能障碍（ED）是心血管疾病发生的危险因素，但也可能参与偏头痛的病理生理过程。PFO封堵术后曾有偏头痛短期加重的报道。我们评估了CS合并PFO患者在PFO封堵前后的内皮功能，以及偏头痛患者内皮功能的变化是否与偏头痛发作频率的改变有关。
纳入CS合并PFO患者；20例计划行PFO封堵术，7例仅接受药物治疗作为对照。通过外周动脉张力测定法（EndoPat）和内皮激活生物标志物评估内皮功能。在基线、术后第1天、1个月和6个月对患者进行纵向随访。使用头痛日记评估偏头痛发作频率。
该队列的平均年龄为45.4岁，偏头痛患病率为50%，其中84.6%为MA。基线时EndoPat指数（RHI）的中位数为1.60（四分位间距1.41 - 2.00）。无论是封堵组患者（P = 0.66）还是对照组患者（P = 0.31），RHI均未随时间变化，内皮激活生物标志物也无变化。3例偏头痛患者在封堵术后偏头痛发作频率直接加重。
PFO封堵术后内皮功能未改变。尽管患者缺乏心血管危险因素，但仍有很大比例的患者存在内皮功能受损。ED是否具有预测价值，识别复发卒中风险较高的PFO值得进一步研究。
