Background

It is still disputable whether the specific morphologic properties of patent foramen ovale (PFO) may contribute to the occurrence of stroke. The aim of this study was to evaluate the differences in the morphometric and functional features of the PFO channel in patients with cryptogenic stroke and those without stroke.

Methods

PFO channel morphology in 106 consecutive patients with cryptogenic stroke and 93 control patients without stroke with diagnosed PFO (by transesophageal echocardiography) was analyzed using transesophageal echocardiography. A validation cohort was established that consisted of 31 patients with cryptogenic stroke and 30 without stroke.

Results

Multivariable regression logistic analyses indicated PFO channel length change (odds ratio [OR], 2.50; 95% confidence interval [CI], 1.75–3.55; P < .001), PFO length/height ratio during the Valsalva maneuver (OR, 0.75; 95% CI, 0.60–0.95; P = .015), septum primum thickness (OR, 0.34; 95% CI, 0.14–0.80; P = .013), septum secundum height (OR, 0.91; 95% CI, 0.84–0.98; P = .013), the presence of an atrial septal aneurysm (OR, 3.38; 95% CI, 1.27–8.97; P = .014), and large shunt (OR, 2.49; 95% CI, 1.13–5.46; P = .022) as PFO-related stroke factors. The Morphologic Stroke Factors of PFO (MorPFO) score was developed, in which six factors were included: PFO channel length reduction (≥21%; 7 points), short septum secundum (<8.6 mm; 5 points), thin septum primum (<1.6 mm; 3 points), large right-to-left shunt (3 points), low PFO channel length/height ratio during the Valsalva maneuver (≤2.1; 2 points), and atrial septal aneurysm presence (1 point). Patients with scores of 0 to 7 points have low-risk PFO channels, those with scores of 8 to 11 points have intermediate-risk PFO channels, and those with scores of 12 to 21 points have high-risk PFO channels. External validation showed good MorPFO score performance (C index = 0.90).

Conclusions

Transesophageal echocardiography can be used to differentiate pathogenic from incidental PFO channels on the basis of their morphologic characteristics. The MorPFO score may help identify high-stroke-risk PFO channels.

中文翻译：

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与隐源性卒中相关的卵圆孔未闭形态特征：MorPFO 评分

背景

卵圆孔未闭（PFO）的特定形态学特征是否可能导致卒中的发生仍存在争议。本研究的目的是评估隐源性卒中患者和非卒中患者 PFO 通道形态和功能特征的差异。

方法

使用经食道超声心动图分析了 106 例隐源性卒中患者和 93 例未确诊为 PFO（经食管超声心动图）的对照患者的 PFO 通道形态。建立了一个验证队列，由 31 名隐源性卒中患者和 30 名非卒中患者组成。

结果

多变量回归逻辑分析表明 PFO 通道长度发生变化（优势比 [OR]，2.50；95% 置信区间 [CI]，1.75–3.55；P  < .001），Valsalva 动作期间 PFO 长度/高度比（OR，0.75； 95% CI, 0.60–0.95; P  = .015)，原发隔厚度 (OR, 0.34; 95% CI, 0.14–0.80; P  = .013)，继发隔高度 (OR, 0.91; 95% CI, 0.84– 0.98；P  = .013），存在房间隔瘤（OR，3.38；95% CI，1.27–8.97；P  = .014）和大分流（OR，2.49；95% CI，1.13–5.46；磷 = .022）作为 PFO 相关的卒中因子。制定了 PFO 的形态学卒中因素 (MorPFO) 评分，其中包括 6 个因素：PFO 通道长度减少（≥21%；7 分）、继发孔短（<8.6 mm；5 分）、原发间隔变薄（< 1.6 mm；3 分），大的右向左分流（3 分），Valsalva 动作期间的低 PFO 通道长度/高度比（≤2.1；2 分）和房间隔动脉瘤存在（1 分）。评分为0～7分的患者为低危PFO通道，评分为8～11分的患者为中危PFO通道，评分为12～21分的患者为高危PFO通道。外部验证显示出良好的 MorPFO 评分表现（C 指数 = 0.90）。

结论

经食道超声心动图可根据其形态特征区分致病性和偶发性 PFO 通道。MorPFO 评分可能有助于识别高卒中风险的 PFO 通道。