Is the search for right-to-left shunt still worthwhile?
Is the search for right-to-left shunt still worthwhile?
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DOI：
10.1111/ane.12456
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发表时间：
2016-04-01
影响因子：
3.5
通讯作者：
Anzola, G. P.
中科院分区：
文献类型：
--
作者：
Tanzi, A.;Onorato, E.;Anzola, G. P.
目的卵圆孔未闭（PFO）是一种常见的非胚性缺陷，其患病率已得到充分证实，但与隐源性脑卒中和不同临床情况的发病关系尚不明确。经颅彩色编码多普勒（TCCD）保证了诊断右至左分流（RLS）及其功能方面的准确性。该研究的目的是评估接受TCCD治疗的受试者的RLS患病率和程度，这些受试者在理论上与脑内矛盾栓塞有关或由其引起。方法对10个主要诊断类别和对照组进行spfo评估，分别采用10个或20个微泡（MB）截止的标准化方案来识别任何或仅识别大的RLS。结果在2113例患者中，卒中（53.3%）、TIA（45.7%）和先兆偏头痛（39.7%）的RLS患病率明显高于非偏头痛对照组（25.5%）。卒中和TIA患者的RLS程度明显更高：来自MB负荷数据的ROC曲线有助于确定正常呼吸（42 MB）和Valsalva （139 MB）试验的新临界值。从逻辑回归来看，PFO家族史、ASA和男性性别是RLS的独立预测因素。相比之下，RLS似乎与脑神经成像或中风模拟中出现的白质异常无关。结论在评估PFO及相关脑血管风险时，除近期确定的标准外，还应考虑遗传决定的遗传特征和流行病学特征（男性）。新定义的TCCD MB计数阈值可以区分与脑卒中和TIA相关的分流与无关的分流。
ObjectivesPatent foramen ovale (PFO) is a common disembryogenic defect with well-attested prevalence but dubious etiopathogenetic linkage with cryptogenic stroke and different clinical conditions. Transcranial color-coded Doppler (TCCD) assures high accuracy in diagnosing right-to-left shunt (RLS) and its functional aspects. Aim of the study was to evaluate RLS prevalence and degree in subjects submitted to TCCD for conditions theoretically associated or caused by paradoxical embolism to the brain.MethodsPFO assessment, performed in 10 major diagnostic categories and a control group, followed a standardized protocol with a 10 or 20 microbubbles (MB) cutoff to identify any or only large RLS, respectively.ResultsAmong 2113 patients, a significant larger RLS prevalence was found in stroke (53.3%), TIA (45.7%) and migraine with aura (39.7%) when compared with non-migraineurs controls (25.5%). RLS degree was significantly higher in stroke and TIA patients: The ROC curve from MB load data helped to identify new cutoff values for both normal breathing (42 MB) and Valsalva (139 MB) tests. From logistic regression, a family history for PFO, ASA, and male gender appeared independent predictors of a RLS. By contrast, RLS seemed independent of white matter abnormalities presence on brain neuroimaging or stroke mimics.ConclusionsIn addition to recently defined criteria, genetically determined inheritable traits and epidemiologic characteristics (male gender) should be taken into account when assessing PFO and related cerebrovascular risk profile. A newly defined threshold in TCCD MB count is suggested to discriminate shunts related to stroke and TIA from innocent ones.