Effect of Residual Interatrial Shunt on Migraine Burden After Transcatheter Closure of Patent Foramen Ovale
Effect of Residual Interatrial Shunt on Migraine Burden After Transcatheter Closure of Patent Foramen Ovale
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DOI：
10.1016/j.jcin.2019.09.042
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发表时间：
2020-02-10
影响因子：
11.3
通讯作者：
Palacios, Igor F.
中科院分区：
文献类型：
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作者：
Ben-Assa, Eyal;Rengifo-Moreno, Pablo;Palacios, Igor F.
目的评价经导管卵圆孔未闭(PFO)封堵术对有先兆和无先兆的偏头痛患者的远期疗效，以及残余右向左分流的疗效。背景：许多研究报道了封堵PFO后偏头痛症状的改善，但随机试验均未达到临床终点。患者在基线和随访时完成了偏头痛负担问卷调查。偏头痛的严重程度报告为偏头痛频率(天/月)、平均持续时间(分钟)和偏头痛负担(天×分钟/月)。闭合后的改善被定义为完全消除症状或偏头痛负担减少50%。结果共纳入110例接受PFO闭合的偏头痛患者，77.0%有先兆，23.0%没有先兆，91.0%有隐源性中风。在中位数3.2(四分位数范围：2.1至4.9)年的长期随访中，有先兆或无先兆的偏头痛患者的偏头痛症状均有显著改善。87.0%的患者偏头痛负担减轻了50%，48%的患者症状完全消除。先兆的存在与偏头痛的消除有关(优势比：4.3；95%可信区间：1.5-12.30；p=0.006)。在PFO关闭后6个月，26%的患者存在残余的右向左分流。无右向左分流与偏头痛负荷改善50%相关(优势比：4.6；95%可信区间：1.3~16.10；p=0.017)。结论经导管肺静脉闭合术后的长期随访与偏头痛负荷的显著改善有关。气场是消除症状的预测指标。缺乏从右向左的残余分流是偏头痛负担显著减轻的预测指标。(C)2020年，由美国心脏病学会基金会提供。
OBJECTIVES This study sought to evaluate the long-term effect of transcatheter patent foramen ovale (PFO) closure on migraineurs with and without aura and examine the effect of residual right-to-left shunt.BACKGROUND Many studies reported improvement in migraine symptoms after PFO closure, yet randomized trials failed to reach its clinical endpoints.METHODS The study retrospectively analyzed data from 474 patients who underwent transcatheter PFO closure at Massachusetts General Hospital. Patients completed a migraine burden questionnaire at baseline and at follow-up. Migraine severity is reported as migraine frequency (days/month), average duration (min), and migraine burden (days x min/month). Improvement following closure was defined as complete abolishment of symptoms or >50% reduction in migraine burden.RESULTS A total of 110 migraineurs who underwent PFO closure were included; 77.0% had aura and 23.0% were without aura, and 91.0% had a cryptogenic stroke. During long-term median follow-up of 3.2 (interquartile range: 2.1 to 4.9) years, there was a significant improvement in migraine symptoms in migraineurs with or without aura. Migraine burden was reduced by >50% in 87.0% of patients, and symptoms were completely abolished in 48%. Presence of aura was associated with abolishment of migraine (odds ratio: 4.30; 95% confidence interval: 1.50 to 12.30; p = 0.006). At 6 months after PFO closure, residual right-to-left shunt was present in 26% of patients. Absence of right-to-left shunt was associated with improvement in migraine burden by >50% (odds ratio: 4.60; 95% confidence interval: 1.30 to 16.10; p = 0.017).CONCLUSIONS Long-term follow-up after transcatheter PFO closure was associated with significant improvement in migraine burden. Aura was a predictor of abolishing symptoms. Absence of residual right-to-left shunt was a predictor of significant reduction in migraine burden. (C) 2020 by the American College of Cardiology Foundation.