Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.).
Toulon Military Hospital, Toulon, France (N.P.).
Ann Intern Med. 2019 Jun 4;170(11):756-763. doi: 10.7326/M18-3485. Epub 2019 May 7.
Pulmonary embolism (PE) is associated with increased risk for ischemic stroke, but the underlying mechanism remains unclear. The authors hypothesized that paradoxical embolism through patent foramen ovale (PFO) should be the main mechanism.
To determine the frequency of recent ischemic stroke in patients with symptomatic PE according to whether PFO was detected.
Prospective cohort study with masked assessment of stroke outcomes. (ClinicalTrials.gov: NCT01216423).
4 French hospital centers.
361 consecutive patients with symptomatic acute PE from 13 November 2009 through 21 December 2015.
Systematic contrast transthoracic echocardiography (TTE) and cerebral magnetic resonance imaging (MRI) within 7 days after enrollment.
Recent symptomatic or silent ischemic stroke was diagnosed on the basis of clinical examination and cerebral MRI showing a hypersignal on the trace diffusion-weighted image with reduction or pseudonormalization of apparent diffusion coefficient.
Contrast TTE was conclusive in 324 of 361 patients and showed PFO in 43 patients (13%). The median age was 66 years (interquartile range, 54 to 77 years). In total, 51% of patients (145/284) had associated deep venous thrombosis, 91% (279/306) had cardiovascular risk factors, and 10% (16/151) presented with arrhythmia (no difference between PFO and non-PFO groups). Cerebral MRI was conclusive in 315 patients. Recent ischemic stroke was more frequent in the PFO group than in the non-PFO group (9 of 42 patients [21.4%] vs. 15 of 273 patients [5.5%]; difference in proportions, 15.9 percentage points [95% CI, 4.7 to 30.7 percentage points]).
Because of inconclusive contrast TTE or MRI, 46 patients were excluded from analysis.
Frequency of recent ischemic stroke in patients with symptomatic PE was higher in patients with PFO than in those without PFO. This finding supports the hypothesis that paradoxical embolism is an important mechanism of ischemic stroke in patients with PFO.
French Ministry of Health.
肺栓塞（PE）与缺血性卒中风险增加相关，但潜在机制尚不清楚。作者假设卵圆孔未闭（PFO）导致的反常栓塞应为主要机制。
根据是否检测到 PFO，确定有症状的 PE 患者中近期缺血性卒中的发生频率。
前瞻性队列研究，卒中结局评估设盲。（ClinicalTrials.gov：NCT01216423）。
法国 4 家医院中心。
2009 年 11 月 13 日至 2015 年 12 月 21 日期间连续纳入的 361 例有症状的急性 PE 患者。
在入组后 7 天内行系统对比经胸超声心动图（TTE）和脑磁共振成像（MRI）。
根据临床检查和脑 MRI 结果诊断近期有症状或无症状的缺血性卒中，MRI 显示弥散加权成像上的高信号，表观弥散系数减少或假性正常化。
361 例患者中 324 例 TTE 结果明确，其中 43 例（13%）存在 PFO。中位年龄为 66 岁（四分位距 5477 岁）。51%（145/284）的患者存在深静脉血栓，91%（279/306）有心血管危险因素，10%（16/151）存在心律失常（PFO 与非 PFO 组间无差异）。315 例患者行脑 MRI 检查。PFO 组近期缺血性卒中的发生率高于非 PFO 组（42 例患者中有 9 例[21.4%] vs. 273 例患者中有 15 例[5.5%]；差异比例为 15.9 个百分点[95%CI，4.730.7 个百分点]）。
由于 TTE 或 MRI 结果不明确，46 例患者被排除在分析之外。
有症状的 PE 患者中，PFO 患者近期缺血性卒中的发生率高于无 PFO 患者。这一发现支持反常栓塞是 PFO 患者发生缺血性卒中的重要机制的假设。
法国卫生部。
