隐源性卒中、不明来源栓塞性卒中和左房间隔囊：经食管超声心动图的作用。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-06-22 DOI:10.1016/j.jstrokecerebrovasdis.2025.108384

Jennifer Xu MD , Jihoon Kang MD , Jonathan Schilling MD MBA , Annlia Paganini-Hill PhD , Marissa Ericson PhD , Jin Kyung Kim MD PhD , Mark Fisher MD

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引用次数: 0

摘要

背景：隐源性卒中在缺血性卒中中占很大比例，由于TOAST分类在识别非典型机制方面的局限性，隐源性卒中常常给诊断带来挑战。左房间隔囊（LASP）是由原间隔和次间隔不完全融合引起的盲端囊，与卵圆孔未闭（PFO）相互排斥。LASP通常通过经食管超声心动图（TEE）诊断，这是一种不常用于评估隐源性卒中或相关实体，不明来源栓塞性卒中（ESUS）的成像方式。因此，LASP可能未被充分诊断和认识为潜在的危险因素。我们研究了LASP与隐源性卒中之间的关系。材料:和。方法：检索PubMed和EMBASE检索相关研究。通过比值比（OR）（未调整）和95%置信区间（CI）估计LASP与隐源性卒中之间的关联。异质性采用基于χ2的q检验。结果：meta分析使用了8项研究，共2075名参与者。我们发现隐源性卒中与LASP存在显著相关（OR 1.60, 95% CI 1.27 ~ 2.02, p < 0.001）。未发现异质性的证据（Q=6.33, p = 0.50）。8项研究中有7项使用TEE进行LASP检测。结论：本系统综述和荟萃分析支持LASP与隐源性卒中之间的关系。鉴于TOAST标准的局限性以及TEE在隐源性卒中和ESUS卒中评估中的应用不足，需要进一步研究LASP在卒中发生中的作用，并在受影响的患者中建立有针对性的预防策略。

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Cryptogenic stroke, embolic stroke of unknown source, and the left atrial septal pouch: the role of transesophageal echocardiography

Background

Cryptogenic stroke accounts for a substantial proportion of ischemic strokes and often poses a diagnostic challenge due to the limitations of the TOAST classification in identifying atypical mechanisms. The left atrial septal pouch (LASP) is a blind-ended pouch arising from the incomplete fusion of the septum primum and septum secundum and is mutually exclusive with a patent foramen ovale (PFO). LASP is typically diagnosed using transesophageal echocardiography (TEE), an imaging modality not routinely utilized in the evaluation of either cryptogenic stroke or a related entity, embolic stroke of unknown source (ESUS). Consequently, LASP may be underdiagnosed and unrecognized as a potential risk factor. We examined the association between LASP and cryptogenic stroke.

Materials and methods

We searched PubMed and EMBASE to identify relevant studies. The association between LASP and cryptogenic stroke was estimated by the odds ratio (OR) (unadjusted) and 95 % confidence interval (CI). Heterogeneity was assessed by χ²-based Q-test.

Results

Eight studies with 2,075 participants were used in the meta-analysis. We found a significant association between cryptogenic stroke and the presence of LASP (OR 1.60, 95 % CI 1.27 to 2.02, p < 0.001). No evidence of heterogeneity was found (Q = 6.33, p = 0.50). Seven of the eight studies utilized TEE for LASP detection.

Conclusion

This systematic review and meta-analysis supports a relationship between LASP and cryptogenic stroke. Given the limitations of the TOAST criteria and the underutilization of TEE in stroke evaluation of cryptogenic stroke and ESUS, further research is needed to characterize LASP's role in stroke occurrence and to establish targeted prevention strategies in affected patients.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.