Département de Médecine interne, Médecine vasculaire et Pneumologie, CHU Brest, Brest, France; EA3878, Université de Bretagne Occidentale, Brest, France.
Département de Médecine interne, Médecine vasculaire et Pneumologie, CHU Brest, Brest, France; EA3878, Université de Bretagne Occidentale, Brest, France.
Thromb Res. 2021 Jun;202:59-66. doi: 10.1016/j.thromres.2021.03.005. Epub 2021 Mar 8.
An increased risk of ischemic stroke in patients with acute pulmonary embolism (PE) and patent foramen ovale (PFO) was reported but few data exist regarding prognostic outcomes of those patients.
Using data in the RIETE registry, we compared the characteristics, therapeutic approaches and outcomes of patients with PE according to the presence or absence of PFO.
From August 2016 to January 2020, 4148 patients with acute PE were enrolled. Of these, 2775 (67%) had no transthoracic echocardiogram (TTE), 993 (24%) underwent TTE but had no reported results on PFO. Among the remaining 380 patients, 287 (74%) did not have PFO and 93 (26%) had PFO. Patients with PFO were more likely to have chronic heart failure, prior myocardial infarction or ischemic stroke than those without PFO. Patients with PFO had a higher rate of subsequent ischemic stroke than those without PFO (hazard ratio (HR): 9.28; 95% CI: 1.83-69.1), than those with TTE but no data on PFO (HR: 10.1; 95% CI: 2.56-42.4) or without TTE (HR: 9.78; 95% CI: 3.02-28.4). On multivariable analysis, patients with PFO were at increased risk for subsequent ischemic stroke than those without PFO (HR: 8.96; 95% CI: 1.68-47.7).
PFO was searched in a minority of patients with an acute PE in real life setting. Subject to possible selection and measurement biases, our results confirmed a higher risk of ischemic stroke in PE patients with PFO compared to those without PFO. This association warrants further investigation before determining the best therapeutic option in patients with acute PE and concomitant PFO.
有报道称，急性肺栓塞（PE）和卵圆孔未闭（PFO）患者发生缺血性卒中的风险增加，但关于这些患者预后结局的数据较少。
利用 RIETE 登记处的数据，我们比较了有和无 PFO 的 PE 患者的特征、治疗方法和结局。
2016 年 8 月至 2020 年 1 月，共纳入 4148 例急性 PE 患者。其中，2775 例（67%）未行经胸超声心动图（TTE），993 例行 TTE 但未报告 PFO 结果。在其余 380 例患者中，287 例（74%）无 PFO，93 例（26%）有 PFO。有 PFO 的患者比无 PFO 的患者更易患有慢性心力衰竭、既往心肌梗死或缺血性卒中。有 PFO 的患者发生后续缺血性卒中的发生率高于无 PFO 的患者（风险比（HR）：9.28；95%置信区间：1.83-69.1）、TTE 但无 PFO 数据的患者（HR：10.1；95%置信区间：2.56-42.4）或无 TTE 的患者（HR：9.78；95%置信区间：3.02-28.4）。多变量分析显示，与无 PFO 的患者相比，有 PFO 的患者发生后续缺血性卒中的风险更高（HR：8.96；95%置信区间：1.68-47.7）。
在真实环境中，只有少数急性 PE 患者进行了 PFO 检查。受可能存在的选择和测量偏倚的影响，我们的研究结果证实，与无 PFO 的患者相比，PE 合并 PFO 的患者发生缺血性卒中的风险更高。在确定急性 PE 合并 PFO 患者的最佳治疗选择之前，还需要进一步研究这一关联。
