Wang Rui, Qiao Miao, Song Guanghui, Wang Wei, Yang Liuyin, Lin Zhenzhen, Meng Lingcui
Department of Ultrasound Imaging, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Front Cardiovasc Med. 2025 Aug 21;12:1647313. doi: 10.3389/fcvm.2025.1647313. eCollection 2025.
Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS), whereas not all PFO carriers experience strokes. Current risk assessment tools like the Risk of Paradoxical Embolism (RoPE) scoring system and PFO-Associated Stroke Causal Likelihood (PASCAL) system have limitations, particularly in elderly populations. This study aims to explore risk factors for PFO-related CS and evaluate age-related differences between younger and elderly patients.
This retrospective study included 344 patients with PFO, categorized into no stroke (NS), cryptogenic stroke (CS), and non-cryptogenic stroke (NCS) groups. Demographic, clinical, laboratory, and detailed PFO anatomical data were collected. Multivariate logistic regression and ROC analysis identified independent risk factors and optimal PFO diameter cut-off. Age subgroup analyses were performed.
17.2% of PFO patients were found to have CS. The mean PFO diameter was significantly larger in CS (2.54 ± 0.79 mm) compared to NS (1.70 ± 0.73 mm) and NCS (1.98 ± 1.10 mm; < 0.05). Multivariate analysis confirmed PFO diameter as an independent CS risk factor (CS vs. NS: OR = 2.215, = 0.001; CS vs. NCS: OR = 1.554, = 0.028). ROC analysis demonstrated good predictive accuracy for CS (AUC = 0.773), with an optimal cut-off of 1.75 mm. Elevated white blood cell count (WBC), age ≥ 60 years, large right-to-left shunt (RLS), previous stroke/transient ischemic attack (TIA) and cortical infarction were associated with CS. Age subgroup analysis showed heterogeneity: in younger patients (<60 years), PFO diameter exhibited predictive capacity (AUC = 0.777, cut-off value = 1.75 mm) but lacked statistical significance in regression analysis ( > 0.05). Large RLS exhibited a risk factor (OR = 7.576, = 0.099). Conversely, among elderly patients (≥60 years), PFO diameter remained a significant predictor (higher cut-off: 1.95 mm; AUC = 0.767), and smoking (OR = 5.26, = 0.043) emerged an additional risk factor.
CS was present in 17.2% of PFO patients. An enlarged diameter of PFO (optimal cut-off value: 1.75 mm in overall and younger; 1.95 mm in elderly) is a crucial anatomical risk factor. Elevated WBC, large RLS, previous stroke/TIA and cortical infarction are also correlated with CS. Age subgroup analysis revealed heterogeneity: PFO anatomy (diameter, RLS) is primary in younger patients, whereas in elderly patients (≥60 years), both PFO anatomy and systemic factors (smoking) should be considered.
卵圆孔未闭（PFO）与不明原因卒中（CS）相关，但并非所有PFO携带者都会发生卒中。目前的风险评估工具，如反常栓塞风险（RoPE）评分系统和PFO相关卒中因果可能性（PASCAL）系统存在局限性，尤其是在老年人群中。本研究旨在探讨PFO相关CS的危险因素，并评估年轻患者和老年患者之间的年龄相关差异。
这项回顾性研究纳入了344例PFO患者，分为无卒中（NS）、不明原因卒中（CS）和非不明原因卒中（NCS）组。收集了人口统计学、临床、实验室和详细的PFO解剖学数据。多因素逻辑回归和ROC分析确定了独立危险因素和最佳PFO直径临界值。进行了年龄亚组分析。
17.2%的PFO患者被发现患有CS。与NS组（1.70±0.73mm）和NCS组（1.98±1.10mm；P<0.05）相比，CS组的平均PFO直径显著更大（2.54±0.79mm）。多因素分析证实PFO直径是CS的独立危险因素（CS与NS相比：OR=2.215，P=0.001；CS与NCS相比：OR=1.554，P=0.028）。ROC分析显示对CS具有良好的预测准确性（AUC=0.773），最佳临界值为1.75mm。白细胞计数（WBC）升高≥60岁、大量右向左分流（RLS）、既往卒中/短暂性脑缺血发作（TIA）和皮质梗死与CS相关。年龄亚组分析显示存在异质性：在年轻患者（<60岁）中，PFO直径具有预测能力（AUC=0.777，临界值=mm），但在回归分析中缺乏统计学意义（P>0.05）。大量RLS是一个危险因素（OR=7.576，P=0.099）。相反，在老年患者（≥岁）中，PFO直径仍然是一个重要的预测因素（更高的临界值：1.95mm；AUC=0.767），吸烟（OR=5.26，P=0.043）成为另一个危险因素。
17.2%的PFO患者存在CS。PFO直径增大（总体和年轻患者的最佳临界值：1.75mm；老年患者为1.95mm）是一个关键的解剖学危险因素。WBC升高、大量RLS、既往卒中/TIA和皮质梗死也与CS相关。年龄亚组分析显示存在异质性：PFO解剖结构（直径、RLS）在年轻患者中起主要作用，而在老年患者（≥60岁）中，应同时考虑PFO解剖结构和全身因素（吸烟）。
