卵圆孔未闭内原位血栓的频率和大小。
Frequency and Size of In Situ Thrombus Within Patent Foramen Ovale.
机构信息
Department of Structural Heart Disease (C.Y., P.Y.), Fuwai Hospital, Beijing, China.
Department of Cardiology, Beijing Tongren Hospital, China (H.L.).
出版信息
Stroke. 2023 May;54(5):1205-1213. doi: 10.1161/STROKEAHA.122.041524. Epub 2023 Mar 9.
BACKGROUND
High-resolution optical coherence tomography can detect in situ thrombi within patent foramen ovale (PFO), which can become a dangerous embolic source. This study aimed to investigate the frequency and size of in situ thrombus within PFO using optical coherence tomography.
METHODS
The cross-sectional study was conducted at Fuwai Hospital (Beijing, China) between 2020 and 2021. From 528 consecutive patients with PFO, 117 (age, 34.33 [SD, 11.30] years) without known vascular risk factors were included; according to PFO-related symptoms, they were divided into the stroke (n=43, including 5 patients with transient ischemic attack), migraine (n=49) and asymptomatic (n=25) groups. Optical coherence tomography was used to evaluate in situ thrombi and abnormal endocardium within PFO. Univariable analysis and a logistic model were used to evaluate the association between stroke and in situ thrombus; age, sex, body mass index, and antithrombotic therapy were included as covariates.
RESULTS
Antithrombotic therapy was used more frequently in the stroke group than in the migraine group (76.7% versus 12.2%; <0.001). In situ PFO thrombi were detected in 36 (83.7%), 28 (57.1%), and 0 (0.0%) patients from the stroke, migraine, and asymptomatic groups, respectively (<0.001). Between the stroke and migraine groups, there was no significant difference in the median (interquartile range) thrombus number per patient (7 [3-12] versus 2 [0-10]; =0.199), maximum thrombus diameter (0.35 [0.20-0.46] versus 0.21 [0-0.68] mm; =0.597), or total thrombus volume (0.02 [0.01-0.05] versus 0.01 [0-0.05] mm; =0.386). Additionally, in situ thrombus was significantly associated with stroke risk (odds ratio, 4.59 [95% CI, 1.26-16.69]). Abnormal endocardium within PFO occurred in patients with in situ thrombi (71.9%) but not in those without. During optical coherence tomography examination, migraine occurred in 2 patients with in situ thrombi.
CONCLUSIONS
The frequency of in situ thrombus was extremely high in stroke and migraine groups, while none of the asymptomatic individuals presented with an in situ thrombus. In situ thrombus formation may play a role in patients with PFO-associated stroke or migraines and have therapeutic implications.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT04686253.
背景
高分辨率光学相干断层扫描可检测到卵圆孔未闭（PFO）内的原位血栓，这些血栓可能成为危险的栓塞源。本研究旨在使用光学相干断层扫描研究 PFO 内原位血栓的频率和大小。
方法
本横断面研究于 2020 年至 2021 年在北京阜外医院进行。从 528 例连续 PFO 患者中，纳入了 117 例（年龄 34.33 [SD，11.30] 岁）无已知血管危险因素的患者；根据 PFO 相关症状，将其分为卒中（n=43，包括 5 例短暂性脑缺血发作患者）、偏头痛（n=49）和无症状（n=25）组。使用光学相干断层扫描评估 PFO 内的原位血栓和异常心内膜。采用单变量分析和逻辑模型评估卒中与原位血栓之间的关系；将年龄、性别、体重指数和抗血栓治疗作为协变量。
结果
卒中组抗血栓治疗的使用率高于偏头痛组（76.7%比 12.2%；<0.001）。在卒中、偏头痛和无症状组患者中，分别有 36 例（83.7%）、28 例（57.1%）和 0 例（0.0%）患者检出 PFO 内原位血栓（<0.001）。卒中组和偏头痛组患者的每例患者的中位（四分位间距）血栓数量（7 [3-12] 比 2 [0-10]；=0.199）、最大血栓直径（0.35 [0.20-0.46] 比 0.21 [0-0.68] mm；=0.597）或总血栓体积（0.02 [0.01-0.05] 比 0.01 [0-0.05] mm；=0.386）均无显著差异。此外，原位血栓与卒中风险显著相关（比值比，4.59 [95%CI，1.26-16.69]）。PFO 内存在异常心内膜的患者（71.9%）存在原位血栓，但不存在原位血栓的患者无异常心内膜。光学相干断层扫描检查时，2 例有原位血栓的患者出现偏头痛。
结论
卒中组和偏头痛组的原位血栓发生率极高，而无症状组均无原位血栓。原位血栓形成可能在 PFO 相关卒中或偏头痛患者中起作用，并具有治疗意义。
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