Factors associated with shunt dynamic in patients with cryptogenic stroke and patent foramen ovale: an observational cohort study

BMC Cardiovascular Disorders

Research Article

Mathias Grebe¹  Nicole Sieweke²  Manfred Kaps²  Christian Tanislav²  Jens Allendörfer³  Maximilian Puille⁴  Frank Reichenberger⁵  Wolfgang Pabst⁶ 

[1] Department of Cardiology, Justus Liebig University Giessen, Klinkstraße 33, 35392, Giessen, Germany;Department of Neurology, Justus Liebig University Giessen, Am Steg 14, 35392, Giessen, Germany;Department of Neurology, Justus Liebig University Giessen, Am Steg 14, 35392, Giessen, Germany;Department of Neurology, Neurologische Klinik Bad Salzhausen, Am Hasensprung 6, 63667, Nidda, Germany;Department of Nuclear Medicine, Justus Liebig University Giessen, Friedrichstraße 25, 35392, Germany;Department of Respiratory Medicine, Justus Liebig University Giessen, Klinkstraße 33, 35392, Giessen, Germany;Institute for Biomedicine and Epidemiology, Justus Liebig University Giessen, Heinrich-Buff-Ring 44, 35392, Giessen, Germany;

关键词: Deep Vein Thrombosis;    Index Event;    Cryptogenic Stroke;    Atrial Septal Aneurysm;    Shunt Volume;   

DOI  :  10.1186/1471-2261-11-54

 received in 2011-06-19, accepted in 2011-08-26,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundAs previously reported there is evidence for a reduction in right to left shunt (RLS) in stroke patients with patent foramen ovale (PFO). This occurs predominantly in patients with cryptogenic stroke (CS). We therefore analysed factors associated with a shunt reduction on follow-up in stroke patients suffering of CS.MethodsOn index event PFO and RLS were proven by transesophageal echocardiography and contrast-enhanced transcranial Doppler-sonography (ce-TCD). Silent PE was proved by ventilation perfusion scintigraphy (V/Q) within the stroke work-up on index event; all scans were re-evaluated in a blinded manner by two experts. The RLS was re-assessed on follow-up by ce-TCD. A reduction in shunt volume was defined as a difference of ≥20 microembolic signals (MES) or the lack of evidence of RLS on follow-up. For subsequent analyses patients with CS were considered; parameters such as deep vein thrombosis (DVT) and silent pulmonary embolism (PE) were analysed.ResultsIn 39 PFO patients suffering of a CS the RLS was re-assessed on follow-up. In all patients (n = 39) with CS a V/Q was performed; the median age was 40 years, 24 (61.5%) patients were female. In 27 patients a reduction in RLS was evident. Silent PE was evident in 18/39 patients (46.2%). Factors such as atrial septum aneurysm, DVT or even silent PE were not associated with RLS dynamics. A greater time delay from index event to follow-up assessment was associated with a decrease in shunt volume (median 12 vs. 6 months, p = 0.013).ConclusionsIn patients with CS a reduction in RLS is not associated with the presence of a venous embolic event such as DVT or silent PE. A greater time delay between the initial and the follow-up investigation increases the likelihood for the detection of a reduction in RLS.

【 授权许可】

CC BY   
© Tanislav et al; licensee BioMed Central Ltd. 2011