PATENT FORAMEN OVALE AND STROKE--A CASE CONTROL STUDY

经卵圆孔未闭(PFO)的矛盾栓塞术 被认为是缺血性中风的可能机制。两个国家的共存 深静脉血栓形成(DVT)和/或高凝状态可能 使PFO患者容易矛盾地将其栓塞到脑部 循环，并可能解释一些中风的起源目前被标记为 是“隐形基因”。建议进行一项病例对照研究，以解决 以下目标： 1.确定PFO是否为缺血性卒中的危险因素，尤其是 未按年龄选择的患者中的隐源性中风； 2.确定PFO是否与DVT和/或高凝状态有关 中风患者的状态，特别是那些有隐源性中风的患者。 次要目标将是评估两年内中风复发的风险 合并和不合并PFO患者分流程度的差异 病例和对照之间的PFO，以及两者之间的潜在关联 高凝状态和中风。 总计300例缺血性中风患者和300例非中风对照患者将 参加这项为期3年的以人群为基础的病例对照研究。学习 受试者将从正在进行的曼哈顿北部中风研究中提取 (NOMASS)，这将确保招聘，同时显著减少 建议书的成本。将通过以下方式确定是否存在PFO 充气生理盐水注射经胸超声心动图。评估 对于DVT的病例，将通过多普勒超声进行检查。一个 高凝状态将被定义为存在 凝血酶原片段F1.2水平、抗磷脂抗体、狼疮 抗凝或功能蛋白S缺乏症。从年的第二年开始 在这项研究中，将对病例进行电话跟踪，以确定 死亡率和中风复发。 将计算优势比，并使用Logistic回归分析 判断潜在暴露变量的独立重要性。 根据检测到的关联(在PFO和中风之间，以及 在PFO和DVT和/或高凝状态之间)，这项研究将设置 评估各种治疗方案疗效的临床试验依据 (抗凝、PFO封闭)可降低卒中复发率。

Paradoxical embolization through a patent foramen ovale (PFO) is considered a possible mechanisms for ischemic stroke. The coexistence of a deep vein thrombosis (DVT) and/or a hypercoagulable state might predispose patients with PFO to paradoxically embolize to the cerebral circulation, and may explain the origin of some strokes currently labeled as "cryptogenic". A case-control study is proposed to address the following aims: 1. To determine if PFO is a risk factor for ischemic stroke, especially cryptogenic stroke, in patients unselected for age; and, 2. To determine if PFO is associated with DVT and/or hypercoagulable states in stroke patients, especially those with cryptogenic stroke. Secondary aims will be to evaluate the 2-year stroke recurrence risk in patients with and without PFO, differences in the degree of shunt through the PFO between cases and controls, and the potential association between hypercoagulable states and stroke. A total of 300 cases of ischemic stroke and 300 stroke-free controls will be enrolled in this 3-year population-based case-control study. Study subjects will be drawn from the ongoing Northern Manhattan Stroke Study (NOMASS), which will assure recruitment while significantly reducing the cost of the proposal. The presence of a PFO will be ascertained by transthoracic echocardiography with aerated saline injection. Evaluation for DVT in cases will be performed by Doppler ultrasound. A hypercoagulable state will be defined as the presence of elevated prothrombin fragment F1.2 levels, antiphospholipid antibodies, Lupus anticoagulant or functional Protein S deficiency. From the second year of the study, a telephone follow-up will be carried out on cases to ascertain mortality and stroke recurrence. Odds ratios will be calculated and logistic regression will be used to judge the independent significance of the potential exposure variables. On the basis of the associations detected (between PFO and stroke, and between PFO and DVT and/or hypercoagulable states), the study will set the ground for clinical trials to assess the efficacy of therapeutic options (anticoagulation, PFO closure) in reducing the stroke recurrence rate.