Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale.
Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale.
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DOI：
10.1161/strokeaha.112.677039
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发表时间：
2013-03
期刊：
影响因子：
8.3
通讯作者：
Kent DM
中科院分区：
文献类型：
--
作者：
Thaler DE;Ruthazer R;Di Angelantonio E;Di Tullio MR;Donovan JS;Elkind MS;Griffith J;Homma S;Jaigobin C;Mas JL;Mattle HP;Michel P;Mono ML;Nedeltchev K;Papetti F;Serena J;Weimar C;Kent DM
卵圆孔未闭（PFO）和隐源性卒中（CS）通常相关，但有些PFO是偶然的。与PFO相关的特殊放射学表现更可能提示PFO相关病因。我们研究了在CS和已知PFO状态的受试者中，特定的放射学检查结果是否与PFO相关。我们分析了具有CS和已知PFO状态的受试者的副动脉栓塞风险（RoPE）数据库，以确定PFO与以下因素之间的关联：1）成像上观察到的索引卒中，2）索引卒中大小，3）索引卒中位置，4）多个索引卒中，和5）基线成像上的既往卒中。我们还比较了成像与所谓的“高风险”超声心动图的特点。如果受试者（n=2680）的指数中风较大（OR 1.36，p=0.0025）、在指数成像上可见（OR 1.53，p=0.003）且位于表面（OR 1.54，p<0.0001），则受试者（n=2680）发生PFO的可能性明显更大。基线影像学检查显示既往卒中与无PFO相关（OR 0.66，p<0.0001）。发现多发性指数卒中与PFO状态无关（OR 1.21，p=0.161）。无超声心动图变量与PFO状态相关。这是报告CS和已知PFO状态患者放射学特征的最大规模研究。与不明显的、较小的或深部卒中以及伴有慢性梗死的卒中相比，大面积、影像学上明显的、位于浅表或与既往影像学梗死无关的卒中更可能与PFO相关。PFO和多发性急性卒中之间没有关联，PFO的特异性超声心动图特征和神经影像学检查结果之间也没有关联。
Patent foramen ovale (PFO) and cryptogenic stroke (CS) are commonly associated but some PFOs are incidental. Specific radiological findings associated with PFO may be more likely to indicate a PFO-related etiology. We examined whether specific radiological findings are associated with PFO among subjects with CS and known PFO status. We analyzed the Risk of Paradoxical Embolism (RoPE) database of subjects with CS and known PFO status, for associations between PFO and: 1) index stroke seen on imaging, 2) index stroke size, 3) index stroke location, 4) multiple index strokes, and 5) prior stroke on baseline imaging. We also compared imaging with purported “high risk” echocardiographic features. Subjects (n=2680) were significantly more likely to have a PFO if their index stroke was large (OR 1.36, p=0.0025), seen on index imaging (OR 1.53, p=0.003), and superficially located (OR 1.54, p<0.0001). A prior stroke on baseline imaging was associated with not having a PFO (OR 0.66, p<0.0001). Finding multiple index strokes was unrelated to PFO status (OR 1.21, p=0.161). No echocardiographic variables were related to PFO status. This is the largest study to report the radiological characteristics of patients with CS and known PFO status. Strokes that were large, radiologically apparent, superficially located, or unassociated with prior radiological infarcts were more likely to be PFO associated than were unapparent, smaller, or deep strokes, and those accompanied by chronic infarcts. There was no association between PFO and multiple acute strokes nor between specific echocardiographic PFO features with neuroimaging findings.