Kahles Timo, Michel Patrik, Hapfelmeier Alexander, Eberli Franz R, Zedde Marialuisa, Thijs Vincent, Kraemer Markus, Engelter Stefan T, Serena Joaquin, Weimar Christian, Mallmann Achim, Luft Andreas, Hemelsoet Dimitri, Thaler David E, Müller-Eichelberg Andreas, De Pauw Adinda, Sztajzel Roman, Armon Carmel, Kent David M, Meier Bernhard, Mattle Heinrich P, Fischer Urs, Arnold Marcel, Mono Marie-Luise, Nedeltchev Krassen
Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
Department of Neurology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Front Neurol. 2020 Jun 4;11:503. doi: 10.3389/fneur.2020.00503. eCollection 2020.
To identify factors associated with prior stroke at presentation in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO). We studied cross-sectional data from the International PFO Consortium Study (NCT00859885). Patients with first-ever stroke and those with prior stroke at baseline were analyzed for an association with PFO-related (right-to-left shunt at rest, atrial septal aneurysm, deep venous thrombosis, pulmonary embolism, and Valsalva maneuver) and PFO-unrelated factors (age, gender, BMI, hypertension, diabetes mellitus, hypercholesterolemia, smoking, migraine, coronary artery disease, aortic plaque). A multivariable analysis was used to adjust effect estimation for confounding, e.g., owing to the age-dependent definition of study groups in this cross-sectional study design. We identified 635 patients with first-ever and 53 patients with prior stroke. Age, BMI, hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease, and right-to-left shunt (RLS) at rest were significantly associated with prior stroke. Using a pre-specified multivariable logistic regression model, age (Odds Ratio 1.06), BMI (OR 1.06), hypercholesterolemia (OR 1.90) and RLS at rest (OR 1.88) were strongly associated with prior stroke.Based on these factors, we developed a nomogram to illustrate the strength of the relation of individual factors to prior stroke. In patients with CS and PFO, the likelihood of prior stroke is associated with both, PFO-related and PFO-unrelated factors.
为了确定隐源性卒中（CS）和卵圆孔未闭（PFO）患者就诊时与既往卒中相关的因素。我们研究了国际PFO联盟研究（NCT00859885）的横断面数据。对首次发生卒中的患者和基线时有既往卒中的患者进行分析，以确定其与PFO相关因素（静息时右向左分流、房间隔瘤、深静脉血栓形成、肺栓塞和Valsalva动作）以及PFO无关因素（年龄、性别、体重指数、高血压、糖尿病、高胆固醇血症、吸烟、偏头痛、冠状动脉疾病、主动脉斑块）之间的关联。采用多变量分析来调整混杂因素的效应估计，例如，由于本横断面研究设计中研究组的年龄依赖性定义。我们确定了635例首次发生卒中的患者和53例有既往卒中的患者。年龄、体重指数、高血压、糖尿病、高胆固醇血症、冠状动脉疾病和静息时右向左分流（RLS）与既往卒中显著相关。使用预先指定的多变量逻辑回归模型，年龄（比值比1.06）、体重指数（OR 1.06）、高胆固醇血症（OR 1.90）和静息时RLS（OR 1.88）与既往卒中密切相关。基于这些因素，我们绘制了一张列线图来说明个体因素与既往卒中关系的强度。在CS和PFO患者中，既往卒中的可能性与PFO相关因素和PFO无关因素均有关。
