Risk Factors Analysis And Construction Of Prediction Model Of Secondary Cerebral Infarction In Patients With Patent Foramen Ovale

Objective: To explore the independent risk factors of secondary cerebral infarction in patients with patent ovale foramen,and to construct and evaluate its prediction model.Methods:Patients with patent foramen ovale admitted to the Second Hospital of Hebei Medical University were prospectively recruited from October 2017 to December 2019.On the basis of whether the patients had cerebral infarction,they were divided into case group(group with secondary cerebral infarction)and control group(group without cerebral infarction).Fasting venous blood samples were collected after admission,and some serological indicators were tested,like homocysteine,total cholesterol,triglycerides.Clinical data was recorded,including some general information(gender,age),related medical history(hypertension,diabetes),smoking history,serological data,imaging data and ultrasound data(right-to-left shunt level).We analyzed these indicators by multivariate logistic regression in order to find the independent risk factors of secondary cerebral infarction in patients with patent foramen ovale.The prediction model was then presented by drawing nomogram and evaluated by ROC curve and calibration curve.Results:A total of 440 patients were enrolled in this study,including 366 with secondary cerebral infarction,and 74 without cerebral infarction.There was no significant correlation between hyperhomocystinemia and secondary cerebral infarction in patients with patent foramen ovale(P>0.05).Neither was hyperlipemia(P>0.05).There was no linear trend between right-to-left shunt level and secondary cerebral infarction of patent foramen ovale(P>0.05).There was a linear trend between hypertension grade and patent foramen ovale secondary cerebral infarction,which means when the patient's hypertension grade increased,the proportion of cerebral infarction would also increased(P<0.05).Although diabetes and smoking history were significantly positively related to secondary cerebral infarction in patients with patent foramen ovale(P<0.05),these two indicators were not the independent risk factors for secondary cerebral infarction in patent foramen ovale(P>0.05).Gender,age and hypertension were independent risk factors for secondary cerebral infarction in patients with patent foramen ovale(P<0.05).Men were 2.382 times more likely than women to have a secondary cerebral infarction among them(OR=2.382,95%CI: 1.387-4.091,P<0.05).In addition,the risk of secondary cerebral infarction in patients with patent foramen ovale would also increased with the growth of age(P<0.05).The calibration curve and ROC curve have supported that the model has have a good fit(AUC=0.725).Conclusion:Gender,age and hypertension are the independent risk factors for secondary cerebral infarction in patients with patent foramen ovale.In the clinic,we can use Nomogram to give a score to the patients with patent foramen ovale to predict the probability of secondary cerebral infarction,so as to scientifically and quickly evaluate the overall condition of the patient to help to make a decision about follow-up,diagnosis and treatment.