Prevalence and size of directly detected patent foramen ovale in migraine with aura
Prevalence and size of directly detected patent foramen ovale in migraine with aura
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DOI：
10.1212/01.wnl.0000179800.73706.20
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发表时间：
2005-11-08
期刊：
影响因子：
9.9
通讯作者：
Seiler, C
中科院分区：
文献类型：
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作者：
Schwerzmann, M;Nedeltchev, K;Seiler, C
背景资料：经颅对比多普勒研究表明，与对照组相比，有先兆的偏头痛患者右向左分流的患病率增加。这些右向左分流的解剖结构和尺寸从未被直接评估。研究方法：在一项横断面病例对照研究中，作者对93例有先兆偏头痛患者和93例健康对照者进行了经食管超声造影。结果如下：44例（47% [95%CI 37 - 58%]）有先兆偏头痛患者和16例（17% [95%CI 10 - 26%]）对照受试者存在卵圆孔未闭（OR 4.56 [95%CI 1.97 - 10.57]; p < 0.001）。偏头痛患者（10% [95%CI 5至18%]）和对照组（10% [95%CI 5至18%]）中小分流的发生率相同，但偏头痛组中发现中等大小或大分流的发生率更高（38% [95%CI 28至48%] vs对照组8% [95%CI 2至13%]; p < 0.001）。存在一个以上的小分流增加了7.78倍（95%CI 2.53至29.30; p < 0.001）的先兆偏头痛的几率。除了卵圆孔未闭的患病率和分流大小外，两组之间没有发现其他超声心动图差异。在有分流和无分流的偏头痛患者中，头痛和基线特征没有差异。结论：近一半的有先兆偏头痛患者有由卵圆孔未闭引起的右向左分流。偏头痛患者的分流管尺寸大于对照组。卵圆孔未闭和未闭患者的偏头痛临床表现是相同的。
Background: Transcranial contrast Doppler studies have shown an increased prevalence of right-to-left shunts in patients with migraine with aura compared with controls. The anatomy and size of these right-to-left shunts have never been directly assessed. Methods: In a cross-sectional case-control study, the authors performed transesophageal contrast echocardiography in 93 consecutive patients with migraine with aura and 93 healthy controls. Results: A patent foramen ovale was present in 44 (47% [95% CI 37 to 58%]) patients with migraine with aura and 16 (17% [95% CI 10 to 26%]) control subjects (OR 4.56 [95% CI 1.97 to 10.57]; p < 0.001). A small shunt was equally prevalent in migraineurs (10% [95% CI 5 to 18%]) and controls (10% [95% CI 5 to 18%]), but a moderate- sized or large shunt was found more often in the migraine group (38% [95% CI 28 to 48%] vs 8% [95% CI 2 to 13%] in controls; p < 0.001). The presence of more than a small shunt increased the odds of having migraine with aura 7.78-fold (95% CI 2.53 to 29.30; p < 0.001). Besides patent foramen ovale prevalence and shunt size, no other echocardiographic differences were found between the study groups. Headache and baseline characteristics did not differ in migraine patients with and without shunt. Conclusions: Nearly half of all patients with migraine with aura have a right-to-left shunt due to a patent foramen ovale. Shunt size is larger in migraineurs than controls. The clinical presentation of migraine is identical in patients with and without a patent foramen ovale.