Zuin Marco, Rigatelli Gianluca, Rigatelli Alberto, Ronco Federico, Conte Luca, Roncon Loris, Mazza Alberto
Section of Internal and Cardiopulmonary Medicine, University of Ferrara Medical School, Ferrara, Italy.
Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
Heart Vessels. 2020 May;35(5):705-711. doi: 10.1007/s00380-019-01528-5. Epub 2019 Nov 1.
The pathophysiological relationship between elevated serum homocysteine (Hcy) levels and patent foramen ovale (PFO) has not yet been completely clarified. In the present study, we assess the correlation between serum homocysteine levels and the RoPE score in PFO patients. We retrospectively reviewed clinical and instrumental data of 244 subjects referred to a single tertiary center for PFO evaluation and/or treatment between January 2010 and January 2018,stratified as closure and control group, respectively. Patients in the closure group had an higher serum Hcy levels compared to the control group (28.5 ± 8.5 vs 10.2 ± 6.6 μg/dL, p < 0.0001). A significant direct correlation was observed between serum Hcy levels and the RoPE Score in the entire population. A positive significant correlation continued to exist also in the closure and control groups (r = 0.472, p < 0.0001 and r = 0.378, p < 0.0001, respectively). A receiver operating characteristics curve identified the optimal cutoff value of homocysteinemia as a predictor of RoPE score > 7 in the closure group (AUC 0.90, 95% CI 0.81-0.94, p < 0.0001) when 19.5 μg/dL. Multivariate logistic regression analysis demonstrated that an Hcy serum level ≥ 19.5 μg/dL predict an RoPE score > 7 (OR 3.21, 95% CI 2.82-3.26, p < 0.0001) in closed patients independently from the presence of permanent right-to-left (RLS) (OR 2.28, 95% CI 2.01-2.43, p = 0.001) and atrial septal aneurysm (ASA) (OR 3.04, 95% CI 2.64-3.51, p < 0.0001). Serum homocysteine levels in PFO patients are positively correlated with the RoPE score. Moreover, a homocysteinemia ≥ 19.5 μg/dL predicts an RoPE score > 7 independently from the presence of a permanent RLS and a concomitant ASA.
血清同型半胱氨酸（Hcy）水平升高与卵圆孔未闭（PFO）之间的病理生理关系尚未完全阐明。在本研究中，我们评估了PFO患者血清同型半胱氨酸水平与RoPE评分之间的相关性。我们回顾性分析了2010年1月至2018年1月期间转诊至单一三级中心进行PFO评估和/或治疗的244名受试者的临床和影像学数据，分别分为封堵组和对照组。封堵组患者的血清Hcy水平高于对照组（28.5±8.5 vs 10.2±6.6μg/dL，p<0.0001）。在整个人群中，观察到血清Hcy水平与RoPE评分之间存在显著的正相关。在封堵组和对照组中也持续存在显著的正相关（r=0.472，p<0.0001和r=0.378，p<0.0001）。受试者工作特征曲线确定了封堵组中高同型半胱氨酸血症作为RoPE评分>7的预测指标的最佳截断值（AUC 0.90，95%CI 0.81-0.94，p<0.0001）为19.5μg/dL。多因素逻辑回归分析表明，在封堵患者中，血清Hcy水平≥19.5μg/dL独立于永久性右向左分流（RLS）（OR 2.28，95%CI 2.01-2.43，p=0.001）和房间隔瘤（ASA）（OR 3.04，95%CI 2.64-3.51，p<0.0001）的存在，可预测RoPE评分>7（OR 3.21，95%CI 2.82-3.26，p<0.0001）。PFO患者的血清同型半胱氨酸水平与RoPE评分呈正相关。此外，高同型半胱氨酸血症≥19.5μg/dL独立于永久性RLS和伴随的ASA的存在，可预测RoPE评分>7。
