Analysis Of Inflammation,Imaging Features And Prognosis Of Ischemic Stroke With Patent Foramen Ovale

Part 1 Analysis of inflammatory markers and Imaging features in ischemic stroke patients with patent foramen ovaleObjective To analysis the inflammatory markers（Systemic Inflammatory Response Index SIRI,Fibrinogen to Albumin Ratio FAR）and imaging features in ischemic stroke patients with patent foramen ovale（PFO）.Method This retrospective study analyzed 71 patients with acute ischemic stroke complicated by PFO who were hospitalized at Zhongnan Hospital of Wuhan University between April 2018 and June 2022.The study examined baseline data,including age,gender,smoking history,drinking history,and other factors,as well as routine biochemical indicators,imaging manifestations,and inflammatory markers such as the systemic inflammatory response index（SIRI）and the ratio of fibrinogen to albumin（FAR）.Infarction type（single or multiple）,transverse diameter（<1.5cm or≥1.5cm）,and whether the stroke occurred in the posterior circulation were also considered.Variables with a p-value of less than 0.05 in univariate analysis and the inflammatory response markers（SIRI and FAR）were included in the multivariate logistic regression model to predict ischemic stroke with PFO.Results（1）There were no significant differences in age,gender,smoking,drinking,and past medical history between the two groups（all P>0.05）.（2）There were no significant differences in hemoglobin,platelet count,blood sugar,total cholesterol,high-density lipoprotein,low-density lipoprotein,liver function,creatinine,fibrinogen,and thrombin time between the two groups（P>0.05）.（3）In the ischemic stroke with PFO group,the lymphocyte count was lower than that in the ischemic stroke without PFO group[1.60（1.24,2.20）×109/L vs 1.90（1.58,2.30）×109/L,Z=-2.087],SIRI[1.35（0.94,1.88）vs 1.10（0.73,1.53）,Z=2.276],and FAR[7.98（6.68,8.94）vs 7.56（6.08,8.43）,Z=1.736].In the PFO group,there were statistical differences in lymphocyte count and SIRI（P<0.01）;however,there were no significant differences in white blood cell count,neutrophil count,and monocyte count between the two groups（all P>0.05）.（4）The ischemic stroke combined with PFO group mainly had multiple infarcts,which accounted for a higher proportion than the ischemic stroke without PFO group[69.0%（49/71）vs 46.5%（33/71）,χ²=7.389].Additionally,the proportion of infarcts located in the posterior circulation was higher than that of the ischemic stroke without PFO group[38.0%（27/71）vs 18.3%（13/71）,χ²=6.822].The differences between the groups were statistically significant（all P<0.01）.There was no significant difference in the proportion of different transverse diameters（<1.5cm or≧1.5cm）between the two groups（P>0.05）.（5）The results of multivariate Logistic regression analysis showed that SIRI（OR=1.79,95%CI 1.09～2.94,P=0.021）,posterior circulation infarction（OR=2.99,95%CI:1.31～6.82,P=0.010）,and multiple infarctions（OR=3.05,95%CI:1.41～6.61,P=0.005）were related to the etiology of PFO.Conclusion The inflammatory markers in ischemic stroke with PFO group were higher than those in the control group,and the Imaging features were multiple,cortical subcortical and posterior circulation infarction.It is inferred that inflammation may play an important role in the pathological process of ischemic stroke with PFO.Part 2 Correlation between inflammatory markers and short-term prognosis in ischemic stroke with patent foramen ovaleObjective: To analysis the correlation between new inflammatory markers（Neutrophil to Lymphocyte Ratio NLR,Fibrinogen to Albumin Ratio FAR）and short-term prognosis of patients with ischemic stroke with patent foramen ovale.Method: From July 2016 to March 2022,91 patients with ischemic stroke with patent foramen ovale（51 cases of intrinsic type and 40 cases of latent type）and 97 patients with ischemic stroke without patent foramen ovale in the same period as control group were selected.The differences of general data,biochemical indexes,NIHSS score and inflammatory markers among the three groups were compared,and the correlation between NLR,FAR and NIHSS score were analyzed.Results: The NIHSS score of ischemic stroke with patent foramen ovale（inherent shunt group and potential triage group）was higher than that of the control group,and the inherent shunt group was significantly higher.The NLR and FAR of ischemic stroke with patent foramen ovale in the inherent shunt group and potential triage group were higher than those in the control group,and higher in inherent shunt group.NLR and FAR levels of ischemic stroke with patent foramen ovale were positively correlated with NIHSS score（r₁=0.58,r₂=0.30,P <0.05）.Conclusion: The severity of neurological injury in patients with ischemic stroke with patent foramen ovale is related to the type of shunt,and the mechanism may be closely related to the increase of inflammatory indexes NLR and FAR.