Yang Hong, Ma Fei, Li Rui, Zhou Qiang, Lin Fan, Zeng Hesong, Wang Dao Wen, Jiang Jiangang, Luo Xiang, Wang Hong
Division of Cardiology and Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China.
Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China.
Rev Cardiovasc Med. 2025 Aug 29;26(8):37480. doi: 10.31083/RCM37480. eCollection 2025 Aug.
The causal relationship between migraines and patent foramen ovale (PFO) remains controversial, and a major unresolved question is how to define migraines attributable to PFO. Thus, this study aimed to determine if brain lesions could be a potential indicator of PFO-related migraines.
Consecutive migraine patients from 2017 to 2019 who underwent transthoracic echocardiography or transcranial Doppler examination with an agitated saline contrast injection were assessed for right-to-left shunts. We then presented diffusion-weighted imaging (DWI) in brain magnetic resonance imaging and its association with PFO in the included patients.
A total of 424 patients with a mean age of 44.39 ± 12.06 years were included in this retrospective study. Among them, 244 patients (57.5%) had PFO, and 246 patients (58%) had subclinical brain lesions-the brain lesions presented as single or multiple scattered lesions. No association was observed between PFO prevalence and brain lesions in the total cohort (odds ratio (OR) 0.499); however, a significant association was observed in patients aged less than 46 years (OR, 3.614 in the group aged <34 years, 95% confidence interval (CI) 1.128-11.580, and 3.132 in the group of 34 years ≤ age < 46 years, 95% CI 1.334-7.350, respectively). Lesions in patients with PFO observed using DWI came more from the anterior or multiple than the posterior vascular territory ( = 0.033). DWI lesion numbers, location, and right-to-left shunt amounts did not affect the association between DWI-observed lesions and PFO.
This study demonstrated that subclinical brain lesions are associated with PFO and may be used as a potential predictor of PFO-related migraines in patients aged less than 46 years. This may help identify candidate patients for PFO closure in future clinical decisions.
偏头痛与卵圆孔未闭（PFO）之间的因果关系仍存在争议，一个主要未解决的问题是如何定义由PFO引起的偏头痛。因此，本研究旨在确定脑损伤是否可能是与PFO相关偏头痛的潜在指标。
对2017年至2019年连续接受经胸超声心动图或经颅多普勒检查并注射振荡生理盐水造影剂的偏头痛患者进行右向左分流评估。然后我们展示了纳入患者脑磁共振成像中的扩散加权成像（DWI）及其与PFO的关联。
本回顾性研究共纳入424例平均年龄为44.39±12.06岁的患者。其中，244例患者（57.5%）有PFO，246例患者（58%）有亚临床脑损伤——脑损伤表现为单个或多个散在病变。在整个队列中未观察到PFO患病率与脑损伤之间的关联（优势比（OR）为0.499）；然而，在年龄小于46岁的患者中观察到显著关联（<34岁组的OR为3.614，95%置信区间（CI）为1.128 - 11.580，34岁≤年龄<46岁组的OR为3.132，95%CI分别为1.334 - 7.350）。使用DWI观察到的PFO患者的病变更多来自前血管区域或多个血管区域而非后血管区域（P = 0.033）。DWI病变数量、位置和右向左分流量均不影响DWI观察到的病变与PFO之间的关联。
本研究表明亚临床脑损伤与PFO相关，并且可能作为年龄小于46岁患者中与PFO相关偏头痛的潜在预测指标。这可能有助于在未来临床决策中识别适合PFO封堵的候选患者。
