Clinical RoPE (cRoPE) score predicts patent foramen ovale detection among stroke patients: a multicenter observational study
Clinical RoPE (cRoPE) score predicts patent foramen ovale detection among stroke patients: a multicenter observational study
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DOI：
10.1007/s10072-020-04386-6
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发表时间：
2020-05-09
影响因子：
3.3
通讯作者：
Consoli, Domenico
中科院分区：
文献类型：
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作者：
Giannandrea, David;Padiglioni, Chiara;Consoli, Domenico
背景卵圆孔未闭（PFO）在隐源性卒中（CS）中的作用一直存在争议。需要预测PFO发生率和可归因分数的工具来指导具有成本效益的诊断和治疗。副动脉栓塞风险（RoPE）评分依赖于神经影像学检查结果，在高达30%的病例中可能不确定。方法我们开发了一种基于临床的简单工具来预测CS患者中PFO的存在和归因分数，而不使用神经影像学。通过德尔菲法从原始RoPE评分中详细阐述了临床RoPE（cRoPE）评分，范围为1-10，用牛津郡社区卒中项目（OCSP）分类（腔隙性卒中= 0分，其他亚型= 1分）取代皮质梗死。然后，从SISIFO（Studio Italiano di prevalenza nello Stroke Ischemico di pervieta del Forame Ovale，或意大利缺血性卒中中卵圆孔未闭的患病率）研究，一项针对连续急性缺血性卒中患者的多中心前瞻性研究（n = 1130）根据急性卒中治疗试验（吐司）和OCSP标准分类并接受PFO检测，我们选择VV-CDC队列（ViboValentia，西塔迪卡斯泰洛，n = 323）来测试cRoPE在预测PFO检测中的准确性。我们将cRoPE与RoPE进行了比较，以验证cRoPE的可靠性。最后，我们通过ROC分析测试了cRoPE依赖于吐司分类的性能。结果总的来说，在VV-CDC中PFO的检出率为21%，在其余SISIFO队列（n = 807）中为23.4%。VV-CDC中的cRoPE（AUC）和RoPE（AUC）相似。CS中的cRoPE性能与RoPE相当（cRoPE（AUC）0.76，95%CI 0.67-0.85，RoPE（AUC）0.75，95%CI 0.66-0.84）。转移到剩余的SISIFO队列，cRoPE证实在CS患者中预测PFO检测的准确性令人满意（cRoPE（AUC）0.71，95%CI 0.66-0.78，p = 0.032）。结论cRoPE可能有助于CS患者的分层，允许准确评估PFO的可能性，特别是在神经影像学不确定的情况下。
Backgroud The role of patent foramen ovale (PFO) in cryptogenic stroke (CS) is debated. Tools to predict PFO occurrence and attributable fraction are needed to guide cost-effective diagnostics and treatment. Risk of Paradoxical Embolism (RoPE) score relies on neuroimaging findings, which might be inconclusive in up to 30% of cases. Methods We developed a clinical-based easy tool to predict the presence and attributable fraction of PFO in CS patients, without using neuroimaging. The clinical RoPE (cRoPE) score, ranging 1-10, was elaborated through Delphi method from the original RoPE score, replacing cortical infarction with the Oxfordshire Community Stroke Project (OCSP) classification (lacunar stroke = 0 points, other subtypes = 1 point). Then, from the SISIFO (Studio Italiano di prevalenza nello Stroke Ischemico di pervieta del Forame Ovale, or Prevalence of Patent Foramen Ovale in Ischemic Stroke in Italy) study, a multicenter, prospective study on consecutive acute ischemic stroke patients (n = 1130) classified by Trial of Org 10172 in Acute Stroke Treatment (TOAST) and OCSP criteria and undergoing PFO testing, we selected the VV-CDC cohort (Vibo Valentia, Citta di Castello, n = 323) to test the accuracy of cRoPE in predicting PFO detection. We compared cRoPE with RoPE to verify cRoPE reliability. Finally, we tested, through ROC analysis, the performance of cRoPE depending on TOAST classification. Results Overall, PFO was detected in 21% in VV-CDC and in 23.4% in remaining SISIFO cohort (n = 807). cRoPE(AUC) and RoPE(AUC) were similar in VV-CDC. cRoPE performance was comparable with RoPE among CS (cRoPE(AUC) 0.76, 95%CI 0.67-0.85, RoPE(AUC) 0.75, 95%CI 0.66-0.84). Moving to the remaining SISIFO cohort, cRoPE confirmed satisfactory accuracy in predicting PFO detection in CS patients (cRoPE(AUC) 0.71, 95%CI 0.66-0.78, p = 0.032). Conclusions Conclusions: cRoPE might help in stratification of patients with CS, allowing accurate esteem of the likelihood of PFO to be found, especially in cases when neuroimaging is inconclusive.