基于经食管超声心动图的卵圆孔未闭形态与隐源性卒中的关系研究

Relationship between the Morphology of Patent Foramen Ovale based on Transesophageal Echocardiography and Cryptogenic Stroke

目的应用经食管超声心动图(tran se sophageal echocard iography,TEE)检查评估隐源性卒中(cryptogenic stroke,CS)患者卵圆孔未闭(patent foramen ovale,PFO)的形态学特征,探讨PFO形态与CS发生的关系。方法回顾性选取2015年3月-2020年1月于大连医科大学附属大连市中心医院行PFO封堵治疗的患者95例,其中CS患者52例(CS组),偏头痛患者43例(偏头痛组)。所有患者均于术前行TEE检查,静息状态测量PFO宽度、PFO通道长度,评估PFO合并房间隔膨出瘤、永存下腔静脉瓣情况,Valsalva状态测量PFO宽度,根据TCD发泡实验(contrast-enhanced transcranial Doppler,c-TCD)判断PFO右向左分流量,以c-TCD双侧微泡栓子信号成帘状或淋浴型为大量右向左分流。比较CS和偏头痛患者PFO上述指标的差异。结果CS组静息状态PFO宽度[1.6(1.1~2.0)mm]与偏头痛组[1.6(0.9~2.0)mm]比较,差异无统计学意义,Valsalva状态PFO宽度(2.18±0.64 mm)大于偏头痛组(1.84±0.82 mm)(P=0.026)。CS组静息状态PFO通道长度(9.63±4.42 mm)与偏头痛组(10.15±4.06 mm)比较差异无统计学意义,PFO合并房间隔膨出瘤患者比例(44.2%)高于偏头痛组(20.9%)(P=0.017),PFO合并永存下腔静脉瓣患者比例(36.5%)高于偏头痛组(16.3%)(P=0.027)。CS组c-TCD大量右向左分流患者比例(90.4%)与偏头痛组(76.7%)比较差异无统计学意义。logistic回归分析结果显示,Valsalva状态PFO宽度(OR 2.261,95%CI 1.191~4.291,P=0.013)是CS发生的独立预测因子。结论Valsalva状态PFO宽度与CS发生有关,Valsalva状态PFO宽度是识别CS的有效参数。

Objective To evaluate the morphological feature of patent foramen ovale(PFO)with transesophageal echocardiography(TEE)in the patients with cryptogenic stroke(CS),and investigate the relationship between PFO morphology and CS.Methods A total of 95 patients who received PFO transcatheter closure in Dalian Municipal Central Hospital affiliated to Dalian Medical University from March 2015 to January 2020 were included in this retrospective study,including 52 patients with CS(CS group)and 43 migraine patients(migraine group).PFO characteristics were evaluated by TEE before the closer.The evaluation parameters of PFO morphological features included the height of PFO tunnel(at rest and during Valsalva maneuver),the length of tunnel,the presence of atrial septal aneurysm,and the presence of prominent Eustachian valve.The magnitude of right-to-left shunt of PFO was determined by contrast-enhanced transcranial Doppler(c-TCD),and the massive right-to-left shunt was defined as detecting the rain curtain sign or shower sign of microbubbles in bilateral middle cerebral arteries.The differences of the above indexes of PFO in patients with CS and migraine were compared.Results There was no statistical difference in the height of PFO(at rest)[1.6(1.1-2.0)mm vs 1.6(0.9-2.0)mm]between the two groups.The height of PFO(during Valsalva maneuver)was greater in the CS group than that in the migraine group(2.18±0.64 mm vs 1.84±0.82 mm,P=0.026).There was no statistical difference in the length of PFO(at rest)(9.63±4.42 mm vs 10.15±4.06 mm)between the two groups.The proportion of atrial septal aneurysm(44.2%vs 20.9%,P=0.017)and prominent Eustachian valve(36.5%vs 16.3%,P=0.027)was higher in the CS group than that in the migraine group.There was no statistical difference in the incidence of massive right-to-left shunts using c-TCD(90.4%vs 76.7%)between the two groups.The logistic regression analysis showed that the height of PFO(during Valsalva maneuver)was an independent predictor for CS(OR 2.261,95%CI 1.191-4.291,P=0.013).Conclusions The height of PFO(during Valsalva maneuver)is associated with CS.The height of PFO(during Valsalva maneuver)is a useful parameter for identifying CS.