Department of Echocardiography Shaoxing People's Hospital Shaoxing China.
Department of Echocardiography The First Affiliated Hospital of Shaoxing University Shaoxing China.
J Am Heart Assoc. 2024 Nov 19;13(22):e035838. doi: 10.1161/JAHA.124.035838. Epub 2024 Nov 7.
Patent foramen ovale (PFO)-associated stroke has a complex and diverse pathogenesis. It mainly results from a paradoxical embolism caused by venous thrombosis. However, few studies have investigated the presence of an in situ thrombus in the right atrium. Transesophageal echocardiography can effectively detect right atrial septal in situ microthrombus. Therefore, we aimed to explore the relationship between a right atrial septal in situ microthrombus and PFO-associated stroke and further dissect the pathophysiological basis of microthrombus formation.
Between April 2022 and October 2023, we prospectively investigated 466 patients who visited our hospital for transesophageal echocardiography with a high clinical suspicion of PFO. Right atrial septal in situ microthrombus was detected in 34 patients (7%), and 23 of them were examined. The microthrombus disappeared in 13 patients and decreased in 7; PFO recanalization and anatomical variations were observed in 2 and 1 patient, respectively. The incidence of index stroke was higher in the microthrombus group than in the nonmicrothrombus group (76.47% versus 61.11%). Univariate and multivariable (adjusted) analyses revealed PFO as an independent risk factor for right atrial septal in situ microthrombus formation (odds ratio, 3.29 [95% CI, 1.49-7.26]; =0.003).
Transesophageal echocardiography effectively detects right atrial septal in situ microthrombus. A PFO may promote the formation of right atrial septal in situ microthrombus. Right atrial septal in situ microthrombus significantly increases the risk of PFO-associated stroke. This finding may be crucial in disease management strategies for patients with PFO.
卵圆孔未闭（PFO）相关性卒中的发病机制复杂且多样。它主要源于由静脉血栓引起的反常栓塞。然而，很少有研究调查右心房内原位血栓的存在。经食管超声心动图可有效检测到右房房间隔内原位微血栓。因此，我们旨在探讨右房房间隔内原位微血栓与 PFO 相关性卒中的关系，并进一步剖析微血栓形成的病理生理基础。
在 2022 年 4 月至 2023 年 10 月期间，我们前瞻性调查了 466 例因高度怀疑 PFO 而就诊于我院行经食管超声心动图的患者。在 34 例（7%）患者中发现了右房房间隔内原位微血栓，其中 23 例进行了检查。微血栓在 13 例患者中消失，7 例患者中减少；在 2 例和 1 例患者中分别观察到 PFO 再通和解剖变异。微血栓组的指数卒中发生率高于非微血栓组（76.47% vs. 61.11%）。单因素和多因素（调整）分析显示，PFO 是右房房间隔内原位微血栓形成的独立危险因素（优势比，3.29 [95%CI，1.49-7.26]；=0.003）。
经食管超声心动图可有效检测到右房房间隔内原位微血栓。PFO 可能促进右房房间隔内原位微血栓的形成。右房房间隔内原位微血栓显著增加了 PFO 相关性卒中的风险。这一发现可能对 PFO 患者的疾病管理策略至关重要。
