Leventis Ioannis A, Sagris Dimitrios, Strambo Davide, Perlepe Kalliopi, Sirimarco Gaia, Nannoni Stefania, Korompoki Eleni, Manios Efstathios, Makaritsis Konstantinos, Vemmos Konstantinos, Michel Patrik, Ntaios George
Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Stroke Center, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
Thromb Haemost. 2021 Mar;121(3):361-365. doi: 10.1055/s-0040-1715831. Epub 2020 Sep 2.
Atrial cardiopathy and likely pathogenic patent foramen ovale (PFO) are two potential embolic sources in patients with embolic stroke of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear.
Atrial cardiopathy was defined as increased left atrial diameter index (> 23 mm/m) or left atrial volume index (> 34 mL/m), or PR prolongation (≥ 200 ms), or presence of supraventricular extrasystoles in the electrocardiograms performed during hospitalization for the index stoke. The presence of PFO was assessed by transthoracic echocardiography with microbubble test or by transesophageal echocardiography. The presence of PFO was considered as likely pathogenic if the Risk of Paradoxical Embolism score was 7 to 10.
Among 367 ESUS patients with available information about the presence of PFO and the presence of atrial cardiopathy (median age: 61 years, 40.6% women), likely pathogenic PFO was diagnosed in 62 (16.9%) and atrial cardiopathy in 122 (33.2%). Only 4 patients (1.1%) had both likely pathogenic PFO and atrial cardiopathy. The prevalence of atrial cardiopathy was lower in patients with likely pathogenic PFO (6.5%) compared with patients with likely incidental PFO (31.2%) or without PFO (40.6%) (Pearson's chi-square test: 26.08, < 0.001; adjusted odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.09-0.86). The prevalence of likely pathogenic PFO was lower in patients with atrial cardiopathy compared with patients without atrial cardiopathy (3.3% vs. 23.7%, respectively [Pearson's chi-square test: 24.13, < 0.001; adjusted OR: 0.2, 95% CI: 0.02-0.6]).
The presence of atrial cardiopathy is inversely related to the presence of likely pathogenic PFO in patients with ESUS.
心房心肌病和可能具有致病性的卵圆孔未闭（PFO）是不明来源栓塞性卒中（ESUS）患者的两种潜在栓子来源。在ESUS患者中，这两种机制之间的关系仍不清楚。
心房心肌病的定义为左心房直径指数增加（>23 mm/m）或左心房容积指数增加（>34 mL/m），或PR间期延长（≥200 ms），或在因首次卒中住院期间进行的心电图检查中存在室上性早搏。通过经胸超声心动图微泡试验或经食管超声心动图评估PFO的存在情况。如果矛盾栓塞风险评分为7至10，则认为PFO的存在可能具有致病性。
在367例有PFO存在和心房心肌病存在相关信息的ESUS患者中（中位年龄：61岁，40.6%为女性），62例（16.9%）被诊断为可能具有致病性的PFO，122例（33.2%）存在心房心肌病。只有4例患者（1.1%）同时患有可能具有致病性的PFO和心房心肌病。与可能为偶然发现的PFO患者（31.2%）或无PFO患者（40.6%）相比，可能具有致病性的PFO患者中心房心肌病的患病率较低（6.5%）（Pearson卡方检验：26.08，<0.001；调整后的优势比[OR]：0.28，95%置信区间[CI]：0.09 - 0.86）。与无心房心肌病的患者相比，有心房心肌病的患者中可能具有致病性的PFO患病率较低（分别为3.3%和23.7%）（Pearson卡方检验：24.13，<0.001；调整后的OR：0.2，95% CI：0.02 - 0.6）。
在ESUS患者中，心房心肌病的存在与可能具有致病性的PFO的存在呈负相关。
