c-TTE evaluation of right-to-left shunt of patent foramen ovale in patients with migraine and relationship with cryptogenic stroke
TONG Fei
HUA Jie
YE Dan
CHEN Xiaowu
Abstract：Objective To explore the right-to-left shunt(RLS)of patent foramen ovale(PFO)in patients with migraine by contrast-enhanced transthoracic echocardiography(c-TTE)evaluation,and to analyze the relationship with cryptogenic stroke(CS).Methods Seventy-four patients with migraine who received treatment in Anqing Shihua Hospital of Nanjing Drum Tower Hospital Group from August 2022 to November 2024 were selected as study subjects for retrospective analysis.According to whether the patients were complicated with CS,they were divided into CS group(n=35)and non-CS group(n=39).All subjects received c-TTE to detect PFO and RLS.RLS was evaluated by contrast-enhanced ultrasound in the resting state and after Valsalva maneuver.According to the microbubble count grading,it was divided into no shunt(grade 0),small shunt(grade I),medium shunt(gradeⅡ)and large shunt(grade Ⅲ).The presence of PFO,RLS grading(gradeⅠ,Ⅱor Ⅲ),PFO aperture,PFO length,valve activity and atrial septal aneurysm(ASA)were recorded in the two groups of patients,and the correlation with CS was explored by Logistic regression analysis.Results c-TTE test revealed that the detection rate of PFO in the CS group was 62.86%(22/35))and that in the non-CS group was 51.28%(20/39),and there was no statistical significance between the two groups(P>0.05).There were 13,7,10 and 5 cases of RLS grade 0,Ⅰ,Ⅱ and Ⅲ in the CS group,and there were 19,14,4 and 2 cases in the non-CS group respectively(P=0.062).The comparison of PFO diameter,length,and valve mobility among patients with RIS grades 0,Ⅰ,Ⅱ and Ⅲ showed statistically significant differences(F=1131.107,281.964,416.390,P<0.001).Multivariate logistic regression analysis revealed that PFO aperture and valve activity were independent risk factors of CS occurrence,and were positively correlated with CS(P<0.05).Conclusion Simple PFO may not be sufficient to cause CS.The anatomical and functional characteristics of PFO are the key factors leading to CS.The larger the diameter of PFO and the range of motion of the valve,the higher the risk of CS occurrence.For migraine patients with combined CS,c-TTE can be used as an effective screening tool to provide a basis for early diagnosis and clinical intervention.
Keywords：migrainecontrast-enhanced transthoracic echocardiographypatent foramen ovaleright-to-left shuntcryptogenic stroke
Publication Date：2025-12-31
Online Publishing Date：2026-01-06(First online date of this platform, not the publication date of the document)
Pages：4( 1011-1014 )