Nighoghossian N, Perinetti M, Barthelet M, Adeleine P, Trouillas P
Service de Neurologie et d'urgences cérébrovasculaires, Pr Paul Trouillas, Lyon, France.
Eur Heart J. 1996 Apr;17(4):590-4. doi: 10.1093/oxfordjournals.eurheartj.a014913.
Minor potential cardioembolic sources of stroke such as atrial septal aneurysm or patent foramen ovale are important risk factors for cryptogenic stroke. We aimed to determine the prevalence of these abnormalities through an exhaustive aetiological work-up. One hundred and eighteen stroke patients under 60 years of age, who had no evidence of a significant cardiac source of embolism, were classified into four groups following transoesophageal echocardiography and assessment of cervical arteries. Group A comprised 30 patients (25.4%) who had an arteriopathy, probably related to stroke without any cardiac abnormality; group B, had only a potential cardiac source; group C, nine (7.6%) had an obvious arterial source of stroke and incidental cardiac abnormalities; group D, 30 (25.4%) had neither cardiac or arterial source. Data were analysed with the Chi-square test to compare risk factors between groups, and variance analysis was used to compare age between groups. Significance was assessed as P < 0.05. Fisher's exact test was used to test the association between arterial septal aneurysm and patient foramen ovale. In groups B and D atrial septal aneurysm represented 56.8% of the cardiac abnormalities and was diagnosed in 35.4% of the 79 patients who had an unexplained stroke, and a patent foramen ovale was found in 34.1% of the patients. According to Fisher's exact test, atrial septal aneurysm was significantly associated with patent foramen ovale (P < < 0.001). On this basis, one fourth of the patients might be said to have had a truly cryptogenic stroke as the aetiological work-up failed to demonstrate any source of stroke. Comparison between groups showed that in 23% of the patients in whom an arterial source was detected, there was also a potential cardioembolic source (group C), vs 62% in patients who had no arterial source (groups B and D) (P = 0.0007). Our study confirmed the strong association between atrial septal aneurysm, patent foramen ovale and stroke. Although there was a lower incidence of cardiac risk factors for stroke in patients who had cervical artery disease, we suggest that all patients who have a stroke without evidence of a major cardiac source should undergo transoesophageal echocardiography, in order to ensure a better prevention.
诸如房间隔瘤或卵圆孔未闭等轻微潜在的心源性卒中栓子来源是不明原因卒中的重要危险因素。我们旨在通过详尽的病因学检查来确定这些异常情况的患病率。118例60岁以下的卒中患者，在经食管超声心动图检查和颈动脉评估后，被分为四组。这些患者均无明显的心源性栓塞证据。A组包括30例患者（25.4%），他们患有动脉病变，可能与卒中相关且无任何心脏异常；B组仅有潜在的心源性栓子来源；C组有9例（7.6%）有明显的动脉源性卒中且伴有偶然发现的心脏异常；D组有30例（25.4%）既无心源性也无动脉源性栓子来源。采用卡方检验分析数据以比较组间危险因素，采用方差分析比较组间年龄。显著性评估为P < 0.05。采用Fisher精确检验来检验房间隔瘤与卵圆孔未闭之间的关联。在B组和D组中，房间隔瘤占心脏异常的56.8%，在79例不明原因卒中患者中有35.4%被诊断出患有房间隔瘤，34.1%的患者发现有卵圆孔未闭。根据Fisher精确检验，房间隔瘤与卵圆孔未闭显著相关（P << 0.001）。在此基础上，由于病因学检查未能显示任何卒中来源，可认为四分之一的患者患有真正的不明原因卒中。组间比较显示，在检测到有动脉源性栓子来源的患者中，23%也有潜在的心源性栓子来源（C组），而在无动脉源性栓子来源的患者中这一比例为62%（B组和D组）（P = 0.0007）。我们的研究证实了房间隔瘤、卵圆孔未闭与卒中之间的密切关联。尽管患有颈动脉疾病的患者中卒中的心源性危险因素发生率较低，但我们建议所有无明显心源性栓子来源的卒中患者都应接受经食管超声心动图检查，以确保更好的预防。
