Analysis Of Risk Factors And Imaging Features Of Patent Foramen Ovale-Associated Stroke

Objective: The purpose of this study was to analyze the risk factors of cryptogenic stroke in patients with patent foramen ovale,to provide evidence for the identification and prevention of high-risk individuals with PFO.Analysis of imaging features of patent foramen ovale related stroke is helpful for early identification of PFO-AS patients.Methods: Hospitalized patients diagnosed with PFO in The Third People’s Hospital of Hubei Province from February 2018 to June 2022 were included,and their basic information,past medical history,24-hour hospitalization laboratory test results and imaging data were collected through the electronic case system.Subjects were screened according to inclusion and exclusion criteria,and the end point was defined as the occurrence of a cryptogenic stroke event.Part I: PFO patients were divided into CS(-)group and CS(+)group according to whether CS occurred.The collected data were statistically analyzed,and independent sample T-test and Chi-square test were used for comparative analysis.Look for meaningful indicators;P < 0.1 was included in multivariate logistic regression analysis to find out the independent risk factors for CS in PFO patients.Part II: The imaging characteristics of patients with PFO complicated with CS were analyzed,and the characteristics of lesions on DWI were counted,including the number of lesions,site of lesions,blood supply area and involved vessels,etc.Patients with small and medium amounts of RLS were divided into small shunt group according to right heart contrast-enhanced ultrasound.A large number of patients with RLS were in the large shunt group,and the imaging lesion characteristics of the groups with different RLS shunt volumes were analyzed.Chi-square test or Fisher’s exact probability method were used for comparative analysis.Results: Part I: A total of 162 patients with patent foramen ovale were enrolled in this study,including 52 in the CS(+)group and 110 in the CS(-)group.The proportion of men,hypertension patients,diabetes patients,smoking history,drinking history and previous stroke history in CS(+)group was higher than that in CS(-)group,and the difference was statistically significant(P < 0.05).The neutrophil count in CS(+)group was higher than that in CS(-)group(4.94±2.50 vs 3.56±1.40,P=0.000),and the NLR value in CS(+)group was higher than that in CS(-)group(3.26±1.91 vs 2.31±1.56,P=0.01).There were no significant differences in age,hyperlipidemia,homocysteine,c reactive protein,lymphocyte count,platelet count and PLR between the two groups.According to multivariate logistic regression analysis,gender(OR=3.537,95%CI 1.382-9.052,P < 0.05)and drinking history(OR=3.470,95%CI 1.175-10.251,P < 0.05)had statistical differences.Part II: 49 patients with PFO combined with CS were included,aged 57.57±12.74 years.The focal features of the 49 patients were as follows.In terms of the number of infarcts,there were 26 cases(53%)of single infarcts and 23 cases(47%)of multiple infarcts.The lesions were distributed in the cortex in 3 cases(6%),subcortical in 21 cases(43%),deep in 16 cases(33%),and mixed in 9 cases(18%).The characteristics of the blood supply area were as follows: 28cases(57%)were in the anterior circulation,15 cases(31%)were in the posterior circulation,and 6 cases(12%)were in the anterior circulation.Based on the vessels involved,37(76%)were in single-vessel mode and 12(24%)were in multi-vessel mode.There was no significant difference between the minor shunt group and the major shunt group in the number of infarcts,distribution sites,blood supply areas,and the number of vascular modes involved.Conclusion: Male patients with PFO are more prone to cryptogenic apoplexy than female patients.PFO patients with hypertension,diabetes,smoking history,drinking history,and previous stroke history have a higher risk of cryptogenic stroke.Gender and drinking history can be used as independent risk factors for PFO-related stroke.Neutrophils,NLR have certain clinical value in predicting cryptogenic stroke in patent foramen ovale.The imaging features of DWI in patients with PFO complicated with CS were mainly subcortical and deep,mostly distributed in the anterior circulation of singlevessel mode lesions,and the proportion of single and multiple lesions was similar.The size of shunt does not affect the number,location or vessel of infarction.