Stone D A, Godard J, Corretti M C, Kittner S J, Sample C, Price T R, Plotnick G D
Department of Medicine, University of Maryland Hospital, Baltimore 21201-1595, USA.
Am Heart J. 1996 Jan;131(1):158-61. doi: 10.1016/s0002-8703(96)90065-4.
This study investigated whether there is an association between the degree of interatrial shunting across a patent foramen ovale, as determined by saline contrast transesophageal echocardiography, and the risk of subsequent systemic embolic events, including stroke. Thirty-four patients found to have foramen ovale during transesophageal echocardiography were divided into two groups on the basis of the maximum number of microbubbles in the left heart in any single frame after intravenous saline contrast injection: group 1 (n = 16) with a "large" degree of shunt ( > or = 20 microbubbles) and group 2 (n = 18) with a "small" degree of shunt ( > or = 3 microbubbles). Patients were followed up over a mean period of 21 months for subsequent systemic embolic events, including transient ischemic attack and stroke. Five (31%) of the patients with large shunts had subsequent ischemic neurologic events, whereas none of the patients with small shunts had embolic events (p = 0.03). These events occurred in spite of antiplatelet or anticoagulant therapy. We conclude that patients with a large degree of shunt across a patient foramen ovale, as determined by contrast transesophageal echocardiography, are at a significantly higher risk of subsequent adverse neurologic events compared with patients with a small degree of shunt.
本研究旨在探讨经盐水对比剂经食管超声心动图测定的卵圆孔未闭时心房分流程度与包括中风在内的后续全身性栓塞事件风险之间是否存在关联。在经食管超声心动图检查中发现有卵圆孔未闭的34例患者，根据静脉注射盐水对比剂后任一单帧左心室内微泡的最大数量分为两组：1组（n = 16）为“大量”分流（≥20个微泡），2组（n = 18）为“少量”分流（≥3个微泡）。对患者进行平均21个月的随访，观察后续全身性栓塞事件，包括短暂性脑缺血发作和中风。大量分流患者中有5例（31%）发生了后续缺血性神经事件，而少量分流患者中无一例发生栓塞事件（p = 0.03）。尽管进行了抗血小板或抗凝治疗，这些事件仍有发生。我们得出结论，经对比剂经食管超声心动图测定，卵圆孔未闭大量分流的患者与少量分流患者相比，发生后续不良神经事件的风险显著更高。
