Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107246. doi: 10.1016/j.jstrokecerebrovasdis.2023.107246. Epub 2023 Aug 1.
Paradoxical embolism under elevated thromboembolic conditions is known to be the primary mechanism of patent foramen ovale (PFO)-related stroke. We hypothesized that higher levels of D-dimer, a marker of thromboembolism, could increase the risk of stroke recurrence in patients with PFO.
We conducted a retrospective analysis of data from 1226 consecutive patients with acute ischemic cryptogenic stroke (CS) who underwent transesophageal echocardiography (TEE). D-dimer was assessed during admission. We used a multivariate Cox proportional hazards model to evaluate the association of long-term outcomes between the presence of PFO and levels of D-dimer.
Of the 1226 patients, the study included 461 who underwent TEE. Among them, 242 (52.5%) had PFOs. Among PFO patients, those with a D-dimer level >1.0 mg/L had a significantly higher risk of stroke recurrence compared to those with <0.5mg/L (adjusted hazard ratio (aHR) 4.04, 95% confidence interval [CI] 1.63-10.02). A pattern of increased risk of event with increasing D-dimer levels was observed (P=0.008). However, there was no significant difference in the risk of stroke recurrence at any D-dimer level compared to D-dimer level <0.5 mg/L among patients without PFO. In these patients, there was little evidence of increased risk with increasing D-dimer levels (P=0.570).
This study demonstrated that the elevated D-dimer level increased the recurrence of stroke in CS patients with PFO, particularly showing a dose-dependent relationship between D-dimer levels and recurrence. However, no such effect was observed in patients without PFO. These findings provide valuable insights into the potential benefits of anticoagulation for strokes related to PFO.
在血栓栓塞条件升高的情况下，反常栓塞被认为是卵圆孔未闭（PFO）相关卒中的主要机制。我们假设更高水平的 D-二聚体（血栓栓塞的标志物）会增加 PFO 患者卒中复发的风险。
我们对 1226 例急性隐源性缺血性卒中（CS）患者的连续数据进行了回顾性分析，这些患者均接受了经食管超声心动图（TEE）检查。在入院时评估了 D-二聚体水平。我们使用多变量 Cox 比例风险模型评估了 PFO 存在与 D-二聚体水平之间的长期结局之间的关联。
在 1226 例患者中，有 461 例接受了 TEE 检查。其中，242 例（52.5%）存在 PFO。在 PFO 患者中，D-二聚体水平>1.0mg/L 的患者卒中复发的风险显著高于 D-二聚体水平<0.5mg/L 的患者（调整后的危险比[aHR]4.04，95%置信区间[CI]1.63-10.02）。随着 D-二聚体水平的升高，观察到事件风险增加的趋势（P=0.008）。然而，在没有 PFO 的患者中，与 D-二聚体水平<0.5mg/L 相比，任何 D-二聚体水平的卒中复发风险均无显著差异。在这些患者中，随着 D-二聚体水平的升高，风险增加的证据很少（P=0.570）。
本研究表明，升高的 D-二聚体水平增加了 PFO 合并 CS 患者的卒中复发风险，尤其是在 D-二聚体水平与复发之间存在剂量依赖性关系。然而，在没有 PFO 的患者中没有观察到这种影响。这些发现为 PFO 相关卒中抗凝治疗的潜在益处提供了有价值的见解。
