Correlation between patent foramen ovale and ischemic stroke in young and middle-aged patients_West China Medical Journal

Authors：

FENG Dan ¹ , XIANG Ying ¹ ,  LIU Yonghong ¹ , WU Jianjun ² , LAI Haiou ¹ , WANG Yingli ² , SHAO Lin ² , REN Pan ² , YIN Chenglong ¹ , QI Zhanning ¹ , XIA Hui ¹ , WANG Sa ¹

1. Department of Neurology, Xianyang Hospital of Yan’an University, Xianyang, Shaanxi 712000, P. R. China;
2. Department of Ultrasonography, Xianyang Hospital of Yan’an University, Xianyang, Shaanxi 712000, P. R. China;

Corresponding author：

LIU Yonghong, Email: lyhb756@163.com

Keywords：

Ischemic stroke; Patent foramen ovale; Right to left shunt

DOI：

10.7507/1002-0179.201704060

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Objective To know more about the correlation between patent foramen ovale (PFO) and ischemic stroke among young and middle-aged people through analysis on various risk factors of ischemic stroke. Methods Eighty-three patients with cerebral infarction from 15 to 55 years old diagnosed for the first time in the Department of Neurology of Xianyang Hospital between January 2016 and January 2017 were selected as the study subjects. They were divided into two groups, PFO group (n=42) and non-PFO group (n=41). Seventy-eight heathy people from the Physical Examination Department of the same hospital were selected as controls. All patients and heathy subjects underwent transcranial Doppler (TCD) foaming experiments, and the occurrence and shunt volume of PFO were observed. General information and cerebrovascular disease risk factors of the patients were investigated. Results The age of subjects in PFO and non-PFO groups was not significantly different (P>0.05). Among the risk factors, there was no significant difference between the PFO and non-PFO groups in drinking history (P>0.05). The incidences of other ischemic stroke risk factors (hypertension, diabetes, smoking, hyperlipidemia, hyperhomocysteinemia, and carotid arteriosclerosis) in the PFO group were significantly lower than those in the non-PFO group (P<0.05). The rank sum test results showed that large and medium shunt rates of the cerebral infarction group were significantly higher than those of the control group (P<0.05). Conclusions PFO may be one of the cause of ischemic stroke in young and middle-aged people. Pathogenesis of ischemic stroke is likely to have a relationship with the severity of the shunt from right to left.

Citation： FENG Dan, XIANG Ying, LIU Yonghong, WU Jianjun, LAI Haiou, WANG Yingli, SHAO Lin, REN Pan, YIN Chenglong, QI Zhanning, XIA Hui, WANG Sa. Correlation between patent foramen ovale and ischemic stroke in young and middle-aged patients. West China Medical Journal, 2017, 32(5): 674-678. doi: 10.7507/1002-0179.201704060 Copy

1.	Hara H, Virmani R, Ladich E, et al. Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol, 2005, 46(9): 1768-1776.
2.	武春桃, 白晶, 郭珍妮, 等. 195 例正常人右向左分流发生率及特点的研究. 中国卒中杂志, 2014, 03(3): 193-196.
3.	Gupta V, Yesilbursa D, Huang WY, et al. Patent foramen ovale in a large population of ischemic stroke patients: diagnosis, age distribution, gender, and race. Echocardiography, 2008, 25(2): 217-227.
4.	黄岳, 马欣, 华扬, 等. 伴有卵圆孔未闭的隐源性缺血性脑血管病危险因素分析. 中国康复理论与实践, 2012, 18(11): 1062-1065.
5.	Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovaleversus medical therapy after cryptogenic stroke. N Engl J Med, 2013, 368(12): 1092-1100.
6.	Caputi L, Butera G, Anzola GP, et al. Residual shunt after patent foramen ovale closure: preliminary results from Italian patent foramen ovale survey. J Stroke Cerebrovasc Dis, 2013, 22(7): e219-e226.
7.	Davis D, Gregson J, Willeit P, et al. Patent foramen ovale, ischemic stroke and migraine: systematic review and stratified meta-analysis of association studies. Neuroepidemiology, 2013, 40(1): 56-67.
8.	中华医学会神经病学分会. 中国急性缺血性脑卒中诊治指南 2014. 中华神经科杂志, 2015, 48(4): 246-257.
9.	Jauss M, Zanette E. Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography. Cerebrovasc Dis, 2000, 10(6): 490-496.
10.	Hamilton-Craig C, Sestito A, Natale L, et al. Contrast transoesophageal echocardiography remains superior to contrast-enhanced cardiac magnetic resonance imaging for the diagnosis of patent foramen ovale. Eur J Echocardiogr, 2011, 12(3): 222-227.
11.	Timsit S, Breuilly C. Cryptogenic cerebral infarction: from classification to concept. Presse Med, 2009, 38(12): 1832-1842.
12.	Lee JY, Song JK, Song JM, et al. Association between anatomic features of atrial septal abnormalities obtained by omni-plane transesophageal echocardiography and stroke recurrence in cryptogenic stroke patients with patent foramen ovale. Am J Cardiol, 2010, 106(1): 129-134.
13.	Sposato LA, Klein FR, Jáuregui A, et al. Newly diagnosed atrial fibrillation after acute ischemic stroke and transient ischemic attack: importance of immediate and prolonged continuous cardiac monitoring. J Stroke Cerebrovasc Dis, 2012, 21(3): 210-216.
14.	黄岳, 马欣. 隐源性脑梗死的定义及其判定方法的更新和意义. 中国脑血管病杂志, 2011, 8(12): 669-672.
15.	Kitsios GD, Dahabreh IJ, Abu Dabrh AM, et al. Patent foramen ovale closure and medical treatments for secondary stroke prevention: a systematic review of observational and randomized evidence. Stroke, 2012, 43(2): 422-431.
16.	Inglessis I, Elmariah S, Rengifo-Moreno PA, et al. Long-term experience and outcomes with transcatheter closure of patent foramen ovale. JACC Cardiovasc Interv, 2013, 6(11): 1176-1183.
17.	郭珍妮, 杜微, 黄妍, 等. 应用 M-模经颅多普勒超声技术评价头痛与卵圆孔未闭的关系. 中风与神经疾病杂志, 2011, 28(7): 594-596.
18.	Iwamoto T. Currently increasing cardiogenic cerebral embolism, especially in its prevention and treatment. Nihon Ronen Igakkai Zasshi, 2005, 42(5): 504-507.
19.	Hart R G, Catanese L, Perera K S, et al. Embolic Stroke of Undetermined Source: a systematic review and clinical update. Stroke, 2017, 48(4): 867-872.
20.	Lamy C, Giannesini C, Zuber M, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke, 2002, 33(3): 706-711.
21.	Homma S, Di Tullio MR, Sacco RL, et al. Characteristics of patent foramen ovale associated with cryptogenic stroke. A biplane transesophageal echocardiographic study. Stroke, 1994, 25(3): 582-586.
22.	Shariat A, Yaghoubi E, Farazdaghi M, et al. Comparison of medical treatments in cryptogenic stroke patients with patent foramen ovale: a randomized clinical trial. J Res Med Sci, 2013, 18(2): 94-98.
23.	Fischer D, Gardiwal A, Haentjes J, et al. Sustained risk of recurrent thromboembolic events in patients with patent foramen ovale and paradoxical embolism: long-term follow-up over more than 15 years. Clin Res Cardiol, 2012, 101(4): 297-303.
24.	成革胜, 张玉顺, 何璐, 等. 卵圆孔未闭并发不明原因卒中患者封堵治疗的疗效及安全性. 心脏杂志, 2013, 25(3): 280-283.
25.	陈林坤, 罗曙光. 卵圆孔封堵术对比药物治疗预防隐源性脑梗死复发的系统评价//中华医学会, 中华医学会神经病学分会. CCCD2015 第十五次中国脑血管病大会 2015 论文汇编. 北京: 中华医学会, 2015: 2.

1. Hara H, Virmani R, Ladich E, et al. Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol, 2005, 46(9): 1768-1776.
2. 武春桃, 白晶, 郭珍妮, 等. 195 例正常人右向左分流发生率及特点的研究. 中国卒中杂志, 2014, 03(3): 193-196.
3. Gupta V, Yesilbursa D, Huang WY, et al. Patent foramen ovale in a large population of ischemic stroke patients: diagnosis, age distribution, gender, and race. Echocardiography, 2008, 25(2): 217-227.
4. 黄岳, 马欣, 华扬, 等. 伴有卵圆孔未闭的隐源性缺血性脑血管病危险因素分析. 中国康复理论与实践, 2012, 18(11): 1062-1065.
5. Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovaleversus medical therapy after cryptogenic stroke. N Engl J Med, 2013, 368(12): 1092-1100.
6. Caputi L, Butera G, Anzola GP, et al. Residual shunt after patent foramen ovale closure: preliminary results from Italian patent foramen ovale survey. J Stroke Cerebrovasc Dis, 2013, 22(7): e219-e226.
7. Davis D, Gregson J, Willeit P, et al. Patent foramen ovale, ischemic stroke and migraine: systematic review and stratified meta-analysis of association studies. Neuroepidemiology, 2013, 40(1): 56-67.
8. 中华医学会神经病学分会. 中国急性缺血性脑卒中诊治指南 2014. 中华神经科杂志, 2015, 48(4): 246-257.
9. Jauss M, Zanette E. Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography. Cerebrovasc Dis, 2000, 10(6): 490-496.
10. Hamilton-Craig C, Sestito A, Natale L, et al. Contrast transoesophageal echocardiography remains superior to contrast-enhanced cardiac magnetic resonance imaging for the diagnosis of patent foramen ovale. Eur J Echocardiogr, 2011, 12(3): 222-227.
11. Timsit S, Breuilly C. Cryptogenic cerebral infarction: from classification to concept. Presse Med, 2009, 38(12): 1832-1842.
12. Lee JY, Song JK, Song JM, et al. Association between anatomic features of atrial septal abnormalities obtained by omni-plane transesophageal echocardiography and stroke recurrence in cryptogenic stroke patients with patent foramen ovale. Am J Cardiol, 2010, 106(1): 129-134.
13. Sposato LA, Klein FR, Jáuregui A, et al. Newly diagnosed atrial fibrillation after acute ischemic stroke and transient ischemic attack: importance of immediate and prolonged continuous cardiac monitoring. J Stroke Cerebrovasc Dis, 2012, 21(3): 210-216.
14. 黄岳, 马欣. 隐源性脑梗死的定义及其判定方法的更新和意义. 中国脑血管病杂志, 2011, 8(12): 669-672.
15. Kitsios GD, Dahabreh IJ, Abu Dabrh AM, et al. Patent foramen ovale closure and medical treatments for secondary stroke prevention: a systematic review of observational and randomized evidence. Stroke, 2012, 43(2): 422-431.
16. Inglessis I, Elmariah S, Rengifo-Moreno PA, et al. Long-term experience and outcomes with transcatheter closure of patent foramen ovale. JACC Cardiovasc Interv, 2013, 6(11): 1176-1183.
17. 郭珍妮, 杜微, 黄妍, 等. 应用 M-模经颅多普勒超声技术评价头痛与卵圆孔未闭的关系. 中风与神经疾病杂志, 2011, 28(7): 594-596.
18. Iwamoto T. Currently increasing cardiogenic cerebral embolism, especially in its prevention and treatment. Nihon Ronen Igakkai Zasshi, 2005, 42(5): 504-507.
19. Hart R G, Catanese L, Perera K S, et al. Embolic Stroke of Undetermined Source: a systematic review and clinical update. Stroke, 2017, 48(4): 867-872.
20. Lamy C, Giannesini C, Zuber M, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke, 2002, 33(3): 706-711.
21. Homma S, Di Tullio MR, Sacco RL, et al. Characteristics of patent foramen ovale associated with cryptogenic stroke. A biplane transesophageal echocardiographic study. Stroke, 1994, 25(3): 582-586.
22. Shariat A, Yaghoubi E, Farazdaghi M, et al. Comparison of medical treatments in cryptogenic stroke patients with patent foramen ovale: a randomized clinical trial. J Res Med Sci, 2013, 18(2): 94-98.
23. Fischer D, Gardiwal A, Haentjes J, et al. Sustained risk of recurrent thromboembolic events in patients with patent foramen ovale and paradoxical embolism: long-term follow-up over more than 15 years. Clin Res Cardiol, 2012, 101(4): 297-303.
24. 成革胜, 张玉顺, 何璐, 等. 卵圆孔未闭并发不明原因卒中患者封堵治疗的疗效及安全性. 心脏杂志, 2013, 25(3): 280-283.
25. 陈林坤, 罗曙光. 卵圆孔封堵术对比药物治疗预防隐源性脑梗死复发的系统评价//中华医学会, 中华医学会神经病学分会. CCCD2015 第十五次中国脑血管病大会 2015 论文汇编. 北京: 中华医学会, 2015: 2.

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West China Medical Journal

Correlation between patent foramen ovale and ischemic stroke in young and middle-aged patients

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