Clinical Features,Risk Prediction Model And Prognostic Analysis Of Patients With Patent Foramen Ovale-associated Stroke

Objective: To analyze clinical characteristics and heterogeneity of patients with patent foramen ovale-associated stroke(PFO-AS),and to explore the risk factors related to PFO-AS and then screen out independent risk factors to construct and verify the prediction model,at the same time,the prognostic factors of PFO-AS patients were analyzed,in order to optimize the individualized diagnosis and treatment of PFO-AS patients.Methods: This study retrospectively analyzed 228 AIS complicated with PFO patients who admitted to Lanzhou University Second Hospital from January 2017 to August 2022.According to the TOAST classification,AIS patients complicated with PFO were divided into LAA,CE,SAA,SOE and CS groups.Then,the CS group was divided into PFO-AS group and ESUS group according to whether the patients had moderate or high risk PFO,and the patients were also divided into PFO-AS group and non-PFO-AS group.(1)The clinical characteristics of PFO-AS are discussed by comparing and analyzing the indicators among the groups of AIS complicated with PFO.(2)The clinical data of patients in PFO-AS group and non-PFO-AS group were analyzed by univariate and bivariate Logistic analysis,and independent risk factors of PFO-AS were screened out.R program was used to predict the risk in patients with PFO-AS.(3)According to the follow-up results of PFO-AS patients,the short-term m RS of 90 days,long-term m RS of 1 year and m RS at admission were compared to determine whether the symptoms of neurological impairment were improved or not,and the patients were divided into the improved group and the non-improved group to explore the factors related to the prognosis of PFO-AS patients.Results:(1)The analysis of clinical data of AIS patients with PFO in each group showed that,in terms of general information,there were statistical differences in age,smoking history,hypertension history,hyperlipidemia history,previous stroke history,blood pressure at admission among the groups(P<0.05).Only PDW and FIB were different between PFO-AS group and SOE group(P<0.05).In terms of imaging examination,there were statistical differences in RLS grade,LAD,Am,infarct location and infarct size(P<0.05).Further pin-to-pair comparison showed that there were statistical differences between the PFO-AS group and the LAA group in age,hypertension history,blood pressure at admission,Ro PE score,RLS grade(P<0.05).There were significant differences in age,blood pressure at admission,Ro PE score and RLS level between PFO-AS group and CE group(P<0.05).There also were statistical differences between PFO-AS group and SAA group in the above indexes except for the laboratory indexes and LAD,Am of imaging examination(P<0.05).There was no statistical significance between PFO-AS group and SOE group in general clinical data,imaging examination and HCT(P> 0.05),only PDW and FIB were different(P<0.05);Only blood pressure and RLS grade at admission were statistically different between PFO-AS group and ESUS group(P<0.05).(2)The results of comparison between the PFO-AS group and the non-PFO-AS group showed that age(OR=0.915,95%CI =0.8788～0.953,P=0.000),smoking history(OR = 6.679,95%CI=1.861～23.970,P =0.004),previous stroke history(OR = 3.295,95% CI = 1.211～8.969,P=0.020),RLS grade(OR=3.925,95%CI = 1.926～5.639,P<0.001)was an independent risk factor for predicting PFO-AS,and then,the above four independent risk factors were input into R program to build a prediction model,and its C-index = 0.877,indicating good accuracy of the prediction model.(3)Statistical analysis of prognostic indicators in PFO-AS group showed that NIHSS score(P = 0.001),m RS score on admission(P<0.001),MPV/PLT(P=0.028),LAD(P=0.036)had statistically significant in PFOAS patients of short-term prognosis.History of hypertension(P=0.044),diastolic blood pressure on admission(P=0.026),NIHSS score(P=0.001),m RS score on admission(P<0.001)and E/A(P=0.037)may affect the long-term prognosis of PFO-AS patients.Conclusions:(1)PFO-AS patients were more common in young and middle-aged people,and a few were associated with risk factors of cerebrovascular disease.The increase of blood pressure in acute stage of stroke was not obvious.(2)Head MRI infarction in PFO-AS patients is characterized by a single cortical focus,mainly involving the anterior circulatory system.(3)Age,smoking history,stroke history and RLS grade were independent risk factors for PFO-AS.(4)NIHSS score,m RS score on admission,MPV/PLT,LAD were correlated with the short-term prognosis of PFO-AS patients.However,hypertension history,diastolic blood pressure,NIHSS score,m RS score on admission and E/A may affect the long-term prognosis of PFO-AS patients.