Agboola Kolade M, Lee Jin-Moo, Liu Xiaoyan, Novak Eric, Cuculich Phillip S, Cooper Daniel H, Noheria Amit
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.
Pacing Clin Electrophysiol. 2019 Mar;42(3):341-348. doi: 10.1111/pace.13599. Epub 2019 Jan 31.
Cardiovascular implantable electronic device (CIED) leads are a nidus for right atrial thrombi. Right-to-left thromboembolism across a patent foramen ovale (PFO) is a putative mechanism for ischemic stroke and PFO has been associated with stroke. We used a novel unbiased case-only study design to assess the effect modification of PFO-associated ischemic stroke risk by presence of CIED. We hypothesized that presence of CIED, as a nidus for right atrial thrombus formation, magnifies the PFO-ischemic stroke relationship; therefore, among hospitalized ischemic stroke patients we would find a higher prevalence of CIED in patients with PFO.
We included consecutive first ischemic stroke patients admitted to our hospital from 2006 to 2015, who were enrolled in a prospectively maintained stroke registry. PFO was ascertained from documentation on echocardiography, and presence of CIED at time of stroke was determined from chest radiography reports at or prior to hospitalization. We measured distributions of CIED within PFO and control groups and used Fisher's exact test to evaluate the PFO-CIED association among ischemic stroke patients.
We included 7089 patients (age: 64.5 ± 14.9 years, 51% female). Echocardiography diagnosed PFO in 760 (10.7%) patients and CIED was reported on chest radiography in 752 (10.6%) patients. Prevalence of CIED was lower in the PFO (61/760, 8.0%) compared to control group (691/6329, 10.9%), P = 0.015.
Among admitted ischemic stroke patients, we did not find a higher prevalence of CIED in patients with PFO compared to controls. Therefore, in the underlying source population, the presence of CIED did not increase the PFO-associated ischemic stroke risk.
心血管植入式电子设备（CIED）导线是右心房血栓形成的病灶。经卵圆孔未闭（PFO）的右向左血栓栓塞是缺血性卒中的一种可能机制，且PFO与卒中相关。我们采用一种新颖的无偏倚病例对照研究设计，以评估CIED的存在对PFO相关缺血性卒中风险的效应修正作用。我们假设，作为右心房血栓形成病灶的CIED的存在会放大PFO与缺血性卒中的关系；因此，在住院缺血性卒中患者中，我们会发现PFO患者中CIED的患病率更高。
我们纳入了2006年至2015年期间我院收治的连续的首次缺血性卒中患者，这些患者均被纳入前瞻性维护的卒中登记系统。通过超声心动图记录确定PFO，根据住院时或住院前的胸部X线报告确定卒中时CIED的存在情况。我们测量了PFO组和对照组中CIED的分布情况，并使用Fisher精确检验评估缺血性卒中患者中PFO与CIED的关联。
我们纳入了7089例患者（年龄：64.5±14.9岁，51%为女性）。超声心动图诊断出760例（10.7%）患者存在PFO，胸部X线报告显示752例（10.6%）患者有CIED。与对照组（691/6329，10.9%）相比，PFO组中CIED的患病率较低（61/760，8.0%），P = 0.015。
在入院的缺血性卒中患者中，我们未发现PFO患者中CIED的患病率高于对照组。因此，在潜在的源人群中，CIED的存在并未增加PFO相关的缺血性卒中风险。
