Stroke Center, Neurology Service, Department of Clinical Neurosciences, of the Lausanne University Hospital, Lausanne, Switzerland.
Cardiology Service, Department Heart-Vessel of the Lausanne University Hospital, Lausanne, Switzerland.
J Stroke Cerebrovasc Dis. 2024 Jun;33(6):107664. doi: 10.1016/j.jstrokecerebrovasdis.2024.107664. Epub 2024 Feb 28.
Paradoxical embolism from right-to-left shunt through atrial septal defect (ASD) and patent foramen ovale (PFO) is a well-accepted cause of "cryptogenic" strokes (CS). To better understand the pathogenic role of ASD, we compared ASD patients with CS having a high and low likelihood of being PFO-related.
In the Acute Stroke Registry and Analysis of Lausanne, we calculated prevalence of PFO and ASD in CS patients undergoing echocardiography, and calculated odds ratios (OR) when compared to non-CS. Using the Risk of Paradoxical Embolism (RoPE) score, we divided CS PFO patients in high (HL-PFO, RoPE 8-10) and low-likelihood (LL-PFO, RoPE 0-4) PFO-related stroke. We then performed univariate comparison of epidemiological, clinical and radiological variables of ASD patients with both PFO groups.
Among all CS, prevalence of ASD and PFO were 1.3% and 36.8% respectively. When compared to non-CS, ASD and PFO were associated with CS (OR of 5.2, CI= 1.6-16.6, and 2.8, CI= 2.1-3.8). Compared with HL-PFO, ASD patients were older, more often female, had more cardiovascular risk factors and silent strokes. Compared with LL-PFO, ASD patients were younger, more often female, and had less risk factors. No differences were found for clinical and radiological characteristics and clinical outcome.
ASD is a rare stroke risk factor for CS. Since characteristics of such patients lie in-between high and low-likelihood paradoxical PFO-strokes, a thorough work-up for other stroke mechanisms is warranted. Individual evaluation of the likelihood of the ASD being causative for stroke may be preferable over routine ASD closure.
通过房间隔缺损（ASD）和卵圆孔未闭（PFO）的右向左分流，引发反常栓塞是“隐源性”中风（CS）的公认原因。为了更好地了解 ASD 的致病作用，我们比较了 CS 患者中 ASD 与 PFO 相关可能性较高和较低的患者。
在洛桑急性中风登记和分析中，我们计算了行超声心动图检查的 CS 患者中 PFO 和 ASD 的患病率，并与非 CS 患者进行了比较。使用反常栓塞风险（RoPE）评分，我们将 CS PFO 患者分为高可能性（HL-PFO，RoPE 8-10）和低可能性（LL-PFO，RoPE 0-4）相关中风的 PFO。然后，我们对 HL-PFO 和 LL-PFO 两组 ASD 患者的流行病学、临床和影像学变量进行了单变量比较。
在所有 CS 中，ASD 和 PFO 的患病率分别为 1.3%和 36.8%。与非 CS 相比，ASD 和 PFO 与 CS 相关（OR 分别为 5.2，CI=1.6-16.6 和 2.8，CI=2.1-3.8）。与 HL-PFO 相比，ASD 患者年龄较大，女性较多，心血管危险因素更多，中风更多为无症状性。与 LL-PFO 相比，ASD 患者年龄较小，女性更多，危险因素更少。两组患者的临床和影像学特征及临床预后无差异。
ASD 是 CS 少见的中风危险因素。由于此类患者的特征介于高可能性和低可能性反常 PFO 中风之间，因此需要彻底检查其他中风机制。对 ASD 引起中风可能性进行个体化评估可能优于常规 ASD 闭合。
