| Part1 Analysis of the incidence of aortic and mitral valve strands in patients with migraine with auraObjective:To estimate the association between valvular strands and migraine with aura.Methods:Transesophageal echocardiography was performed in consecutive 93 patients with migraine with aura and 52 patients with ischemic stroke and 192 control subjects who underwent transesophageal echocardiography for other purposes and had no history of migraine. The presence of aortic and mitral valve strands were evaluated.Results:The prevalence of valvular strands was 22.6%(21/93) in migraine patients and 34.6%(18/52) in stroke patients and 32.8% (63/192) in control subjects (χ2=3.155, p=0.076; χ2=0.060,p=0.807). The prevalence of mitral valve strands was 7.5% (7/93), 14.5% (7/52) and 15.1% (29/192) in migraine patients and stroke patients and control subjects (χ2=3.260, p=0.071; x2=0.088, p=0.767). The prevalence of aortic valve strands was 18.3%(17/93),26.9%(14/52) and 27.1% (52/192) in migraine patients and stroke patients and control subjects (χ2=2.646, p=0.104; χ2=0.001, p=0.982).Conclusions:Valvular strands were not associated with migraine with aura and also ischemic stroke and showed little clinical significance.Part 2 Analysis of transoesophageal echocardiography in detecting patent foramen ovale in patients with migraine with auraObjective:To evalualtc the association between the incidence and morphological characteristics of patent foramen ovale (PFO) and migraine with aura by transesophageal echocardiography (TEE).Methods:We ascertained the presence of patent foramen ovale using transesophageal echocardiography in consecutive 97 patients in migraine with aura and 314 patients in migraine without aura and 49 healthy control subjects. A patent foramen ovale was diagnosed if color flow was seen through the interatrial septum. Patients with suspected PFO were confirmed by transthoracic contrast echocardiograph(TTCE).Results:A PFO was found in 21 patients with migraine with aura and 4 patients with migraine without aura and 8 control subjects by color Doppler transesophageal echocardiography(x2=0.579, P=0.447). The mean diameter of PFO was similar in migraine patients and control subjects (2.0±1.1mm,1.3±0.5mm,1.6±0.5mm; F=1.054, p=0.361). The prevelance of ASA was similar in migraine patients and control subjects (1.1%,2.9%,0%; p=1.000; p=0.453; p=0.417). There was also no difference in PFO prevelanee between those with migraine with aura and those without and control subjects after TTCE study (30.9%,26.5%,26.5%; χ2=0.303, p=0.582; χ2=0.239, p=0.625, χ2=0.000, p=0.995).Conclusions:The diagnostic accuracy of PFO by color Doppler transesophageal echocardiography is relatively low. TTCE improves the diagnostic accuracy of PFO. But we found no association between migraine and the incidence and morphological characteristics of PFO. echocardiography in consecutive 97 patients in migraine with aura and 314 patients in migraine without aura and 49 healthy control subjects. A patent foramen ovale was diagnosed if color flow was seen through the interatrial septum. Patients with suspected PFO were confirmed by transthoracic contrast echocardiograph(TTCE).Part 3 Analysis of the results of transthoracic contrast echocardiograph in patients with migraine with auraObjective:To estimate the association between the origination and shunt size of right to left shunt (RLS) and migraine with aura.Methods:We performed transthoracic contrast echocardiography(TTCE) in 113 consecutive patients with migraine with aura and 45 patients with migraine without aura and 70 healthy controls. According to the time that microbubbles(MB) occurred and sustained in the left atrium after contrast appearance in the right atrium and the relation to the Valsalva maneuver, the RLS was identified as PFO-RLS or P-RLS. The RLS was semi-quantitated and graded according to the number of MB appearenced in the left atrium:1 to 10 MB as level 1; 11 to 30 MB as level 2; 31 to 50 MB as level 3; 51 to 100 MB as level 4;>100 MB as level 5.Results:There was no difference in PFO-RLS prevalence in those with migraine with aura and those without and control subjects (30.1%,20.0%,20.0%; x2=2.274, p=0.132; χ2=0.164, p=0.198; x2=0.000, p=1.000). The prevalence of P-RLS was similar in migraine patients and control subjects(59.3%,64.4%,61.4%; x2=0.082, p=0.774; χ2=0.358, p=0.549; x2=0.106, p=0.744). The overall incidence of RLS that was not distinguished from the origination was also similar in migraine patients and control subjects(77.9%,62.2%,74.3%; x2=0.310, p=0.578;χ2=0.183, p=0.170). When comparing the semi-quantitation grading of RLS, there was no difference in 1 to 2 level of PFO-RLS prevalence in migraine patients and control subjects(6.2%,13.3%,8.6%; X2=0.097, p=0.755; x2=1.330, p=0.249; x2=0.253, p=0.615). But the prevalence of 3 to 5 level of PFO-RLS in migraine with aura was significantly higher than other two groups(23.9%,6.7%,11.4%;χ2=4.342, p=0.037; x2=6.209, p=0.031). The prevalence of 1 to 2 level of P-RLS in control subjects was significantly higher than patients with migraine with aura(34.5%,42.2%,55.7%; x2=7.944, p=0.005). But the prevalence of 3 to 5 level of PFO-RLS in migraine with aura was significantly higher than control subjects(24.8%,22.2%,5.7%; x2=10.888, p=0.001). The overall incidence of 1 to 2 level of RLS in MA was significantly lower than control subjects(31.9%,42.2%,55.7%; X2=10.170, p=0.001). But the overall incidence of 3 to 5 level of RLS in MA was significantly higher than control subjects(45.1%,28.9%,15.7%; x2=16.99, p=0.000).Conclusions:RLS may not only be originated from PFO but also from pulmonary circulation. We found no association between migraine and the source of RLS. But the large RLS appears to be associated with migraine with aura. |
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