Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China.
Department of Ultrasound, The Third People's Hospital of Yichang City, Yichang, Hubei Province, China.
Ann Clin Transl Neurol. 2022 Sep;9(9):1384-1391. doi: 10.1002/acn3.51638. Epub 2022 Jul 27.
Whether atrial septal aneurysm (ASA) increases the risk of cerebrovascular ischemic events in patients with patent foramen ovale (PFO) remains controversial.
We constructed a detailed meta-analysis to assess the effect of ASA on risk of cerebrovascular ischemic events in patients with PFO.
Randomized controlled trials (RCTs) and observational studies (cohort studies and case-control studies) that compared PFO-ASA against PFO alone were included. Pooled odds ratios (OR) estimates and 95% CI were calculated using the fixed-effect and random-effect models.
Four RCTs and twelve observational studies (five cohort studies and seven case-control studies) contributed to the meta-analysis. The pooled results of case-control studies showed that ASA increased the risk of cerebrovascular ischemic events in patients with PFO (fixed-effect model: OR = 3.69; 95% CI: 2.67-5.09; p < 0.01, random-effect model: OR = 3.63; 95% CI: 2.51-5.24; p < 0.01). However, poole results from RCTs (fixed-effect model: OR = 1.24; 95% CI: 0.78-1.95; p = 0.36, random-effect model: OR = 1.27; 95% CI: 0.78-2.08; p = 0.34) and cohort studies (fixed-effect model: OR = 1.35; 95% CI: 0.81-2.23; p = 0.25, random-effect model: OR = 1.40; 95% CI: 0.84-2.33; p = 0.20) found no evidence. Overall analysis showed that ASA increased the risk of cerebrovascular ischemic events (fixed-effect model: OR = 2.30; 95% CI: 1.84-2.87; p < 0.01, random-effect model: OR = 2.11; 95% CI: 1.48-3.01; p < 0.01). The sensitivity analysis confirmed the stability of all results.
Although case-control studies support ASA to increase the risk of cerebrovascular ischemic events in patients with PFO, RCTs and cohort studies challenged the credibility. Further prospective studies are needed to confirm the effect of ASA on patients with PFO.
房间隔瘤 (ASA) 是否会增加卵圆孔未闭 (PFO) 患者发生脑血管缺血事件的风险仍存在争议。
我们构建了一项详细的荟萃分析，以评估 ASA 对 PFO 患者发生脑血管缺血事件风险的影响。
纳入了比较 PFO-ASA 与单纯 PFO 的随机对照试验 (RCT) 和观察性研究 (队列研究和病例对照研究)。使用固定效应和随机效应模型计算汇总优势比 (OR) 估计值和 95%置信区间。
四项 RCT 和十二项观察性研究 (五项队列研究和七项病例对照研究) 为荟萃分析提供了数据。病例对照研究的汇总结果表明，ASA 增加了 PFO 患者发生脑血管缺血事件的风险 (固定效应模型：OR = 3.69；95%CI：2.67-5.09；p<0.01，随机效应模型：OR = 3.63；95%CI：2.51-5.24；p<0.01)。然而，RCT 汇总结果 (固定效应模型：OR = 1.24；95%CI：0.78-1.95；p = 0.36，随机效应模型：OR = 1.27；95%CI：0.78-2.08；p = 0.34) 和队列研究 (固定效应模型：OR = 1.35；95%CI：0.81-2.23；p = 0.25，随机效应模型：OR = 1.40；95%CI：0.84-2.33；p = 0.20) 并未发现证据。总体分析表明，ASA 增加了 PFO 患者发生脑血管缺血事件的风险 (固定效应模型：OR = 2.30；95%CI：1.84-2.87；p<0.01，随机效应模型：OR = 2.11；95%CI：1.48-3.01；p<0.01)。敏感性分析证实了所有结果的稳定性。
尽管病例对照研究支持 ASA 增加 PFO 患者发生脑血管缺血事件的风险，但 RCT 和队列研究对其可信度提出了挑战。需要进一步的前瞻性研究来证实 ASA 对 PFO 患者的影响。
