Patent Foramen Ovale in Cryptogenic Stroke Incidental or Pathogenic?
Patent Foramen Ovale in Cryptogenic Stroke Incidental or Pathogenic?
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DOI：
10.1161/strokeaha.109.547828
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发表时间：
2009-07-01
期刊：
影响因子：
8.3
通讯作者：
Kent, David M.
中科院分区：
文献类型：
--
作者：
Alsheikh-Ali, Alawi A.;Thaler, David E.;Kent, David M.
背景和目的——卵圆孔未闭（PFO）与隐源性中风（CS）显着相关。然而，即使在 CS 患者中，PFO 也可能是偶然发现的。我们试图估计 CS 患者中 PFO 偶然发生的概率。方法 - 系统搜索确定了 23 项病例对照研究，检查 CS 患者与已知原因中风对照受试者中 PFO 的患病率。使用简单的假设和贝叶斯定理，我们计算了 CS 患者偶发 PFO 的概率。随机效应荟萃分析估计了不同年龄人群（有或无房间隔动脉瘤）中 CS 与对照受试者中 PFO 的比值比 (OR)，并用于总结各研究中 CS 中 PFO 偶然发生的概率。 结果 - CS 与对照受试者中 PFO 的总结 OR (95% CI) 为 2.9（CI，2.1 至 4.0）。年轻患者和老年患者（<或>= 55 岁）的相应 OR 分别为 5.1（3.3 至 7.8）和 2.0（>1.0 至 3.7）。在纳入年龄的研究中，CS 患者偶发 PFO 的相应概率为 33%（28% 至 39%），年轻患者中为 20%（16% 至 25%），老年患者中为 48%（34% 至 66%）。当存在房间隔动脉瘤时，这些概率要低得多。结论——在患有其他 CS 的患者中，大约三分之一的被发现的 PFO 可能是偶然的，因此不会从闭合中受益。这种概率对患者特征（例如年龄和房间隔动脉瘤的存在）敏感，这表明患者选择在治疗决策中的重要性。 （中风。2009；40：2349-2355。）
Background and Purpose-Patent foramen ovale (PFO) is significantly associated with cryptogenic stroke (CS). However, even in patients with CS, a PFO can be an incidental finding. We sought to estimate the probability that a PFO in a patient with CS is incidental.Methods-A systematic search identified 23 case-control studies examining the prevalence of PFO in patients with CS versus control subjects with stroke of known cause. Using simple assumptions and Bayes' theorem, we calculated the probability a PFO is incidental in patients with CS. Random effects meta-analyses estimated the odds ratio (OR) of a PFO in CS versus control subjects in different age populations, with or without atrial septal aneurysms, and were used to summarize across studies the probability that a PFO in CS is incidental.Results-The summary OR (95% CIs) for PFO in CS versus control subjects was 2.9 (CI, 2.1 to 4.0). The corresponding ORs for young and old patients (< or >= 55 years) were 5.1 (3.3 to 7.8) and 2.0 (>1.0 to 3.7), respectively. The corresponding probabilities that a PFO in patients with CS is incidental were 33% (28% to 39%) in age-inclusive studies, 20% (16% to 25%) in younger patients, and 48% (34% to 66%) in older patients. These probabilities were much lower when an atrial septal aneurysm was present.Conclusions-In patients with otherwise CS, approximately one third of discovered PFOs are likely to be incidental and hence not benefit from closure. This probability is sensitive to patient characteristics such as age and the presence of an atrial septal aneurysm, suggesting the importance of patient selection in therapeutic decision-making. (Stroke. 2009; 40: 2349-2355.)