Interatrial septal mobility predicts larger shunts across patent foramen ovales: An analysis with transmitral Doppler scanning
Interatrial septal mobility predicts larger shunts across patent foramen ovales: An analysis with transmitral Doppler scanning
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DOI：
10.1067/mhj.2003.5
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发表时间：
2003-04-01
影响因子：
4.8
通讯作者：
Kerr, AJ
中科院分区：
文献类型：
--
作者：
Fox, ER;Picard, MH;Kerr, AJ
卵圆孔未闭（PFO）与隐源性卒中的相关性在分流较大的患者和房间隔动脉瘤（ASA）患者中最强。我们假设阿萨作为卒中危险因素的效力与通过与移动的房间隔相关的PFO的分流大小有关。本研究的目的是探讨房间隔的流动性和程度的右向左分流与经胸跨膜多普勒扫描（TMD）contrast technique.Methods在165例连续患者，经胸TMD录音期间与患者在休息时和一个动作后，以增加右心房压力的盐水对比研究。气泡过境对应于高强度信号的二尖瓣血流速度包络线和量化的气泡score.Results一PFO被诊断为59例（36%）。在50例PFO且超声心动图图像充分的患者中，阿萨的发生率为52%。在该组中，总间隔活动度和颞叶偏斜均预测了静息时（斯皮尔曼rho分别为0.6，4，0.64，P <0.001）和操作后（斯皮尔曼rho为0.74，0.73，P <0.001）的TMD气泡评分。在28例发生脑缺血事件的患者中，机动气泡评分可预测隐源性卒中（P = 0.02，优势比7.58）。总间隔运动与隐源性卒中之间有显著性趋势（P = 0.06）。结论房间隔运动可预测PFO右向左分流的程度。因此，过度的间隔活动度在中风病因中的作用可能是由于相关的经PFO分流的大小导致矛盾性栓塞的机会更大而引起的。
Background The association of patent foramen ovale (PFO) with cryptogenic stroke is strongest in patients with larger shunts and patients with atrial septal aneurysms (ASAs). We postulated that the potency of ASA as a risk factor for stroke relates to the size of shunt across PFOs associated with mobile atrial septae. The purpose of this study was to investigate the relationship between atrial septal mobility and the degree of right-to-left shunting with a transthoracic transmitral Doppler scanning (TMD) contrast technique.Methods In 165 consecutive patients, transthoracic TMD recordings were made during a saline contrast study with the patient at rest and after a maneuver to increase right atrial pressure. Bubble transit corresponded to high intensity signals in the velocity envelope of the mitral inflow profile and was quantified by a bubble score.Results A PFO was diagnosed in 59 patients (36%). In 50 patients with PFO and adequate echocardiography images, the incidence of ASA was 52%. In this group, both total septal mobility and leftward deviation predicted the TMD bubble score at rest (Spearman rho 0.6,4, 0.64, respectively, P < .001) and after the maneuver (Spearman rho 0.74, 0.73, P < .001). In 28 patients with cerebral ischemic events, the maneuver bubble score was predictive for cryptogenic stroke (P = .02, odds ratio 7.58). There was a trend toward significance between total septal motion and cryptogenic stroke (P = .06).Conclusion Atrial septal mobility predicts the degree of right-to-left shunts across PFOs. The role of excessive septal mobility in the etiology of stroke may therefore be caused by the greater opportunity,for paradoxical embolism because of the size of the associated trans-PFO shunt.