Ignored Role of Paroxysmal Atrial Fibrillation in the Pathophysiology of Cryptogenic Stroke in Patients with Patent Foramen Ovale and Atrial Septal Aneurysm.

IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Current Cardiology Reviews Pub Date : 2024-01-01 DOI:10.2174/011573403X267669240125041203
Ertan Yetkin, Hasan Atmaca, Bilal Çuğlan, Kenan Yalta
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Abstract

The association between cryptogenic stroke (CS) and patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) has been a debate for decades in terms of pathophysiologic processes and clinical courses. This issue has become more interesting and complex, because of the concerns associating the CS with so-called normal variant pathologies of interatrial septum, namely ASA and PFO. While there is an anatomical pathology in the interatrial septum, namely PFO and ASA, the embolic source of stroke is not clearly defined. Moreover, in patients with PFO and CS, the risk of recurrent stroke has also been associated with other PFOunrelated factors, such as hyperlipidemia, body mass index, diabetes mellitus, and hypertension, leading to the difficulty in understanding the pathophysiologic mechanism of CS in patients with PFO and/or ASA. Theoretically, the embolic source of cryptogenic stroke in which PFO and/or ASA has been involved can be categorized into three different anatomical locations, namely PFO tissue and/or ASA tissue itself, right or left atrial chambers, and venous vascular territory distal to the right atrium, i.e., inferior vena cava and lower extremity venous system. However, the possible role of paroxysmal atrial fibrillation associated with PFO and/or ASA as a source of cryptogenic stroke has never been mentioned clearly in the literature. This review aims to explain the association of cryptogenic stroke with PFO and/or ASA in a comprehensive manner, including anatomical, clinical, and mechanistic aspects. The potential role of paroxysmal atrial fibrillation and its contribution to clinical course have been also discussed in a hypothetical manner to elucidate the pathophysiology of CS and support further treatment modalities.

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被忽视的阵发性心房颤动在房间孔和心房隔膜动脉瘤患者隐源性中风的病理生理学中的作用。
数十年来,关于隐源性中风(CS)与伴有或不伴有房间隔动脉瘤(ASA)的卵圆孔未闭(PFO)之间的关系,一直存在着病理生理过程和临床病程方面的争论。由于人们关注 CS 与所谓的正常变异性房间隔病变(即 ASA 和 PFO)之间的关系,这一问题变得更加有趣和复杂。虽然房间隔存在解剖病理,即 PFO 和 ASA,但中风的栓塞源并不明确。此外,在 PFO 和 CS 患者中,复发性卒中的风险还与其他与 PFO 无关的因素有关,如高脂血症、体重指数、糖尿病和高血压等,导致人们难以理解 PFO 和/或 ASA 患者 CS 的病理生理机制。从理论上讲,涉及 PFO 和/或 ASA 的隐源性卒中的栓子来源可分为三个不同的解剖位置,即 PFO 组织和/或 ASA 组织本身、右心房或左心房腔以及右心房远端静脉血管区域,即下腔静脉和下肢静脉系统。然而,文献中从未明确提及与 PFO 和/或 ASA 相关的阵发性心房颤动可能是隐源性卒中的来源。本综述旨在全面解释隐源性卒中与 PFO 和/或 ASA 的关联,包括解剖学、临床和机理方面。此外,还以假设的方式讨论了阵发性心房颤动的潜在作用及其对临床过程的影响,以阐明 CS 的病理生理学并支持进一步的治疗模式。
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来源期刊
Current Cardiology Reviews
Current Cardiology Reviews CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
10.50%
发文量
117
期刊介绍: Current Cardiology Reviews publishes frontier reviews of high quality on all the latest advances on the practical and clinical approach to the diagnosis and treatment of cardiovascular disease. All relevant areas are covered by the journal including arrhythmia, congestive heart failure, cardiomyopathy, congenital heart disease, drugs, methodology, pacing, and preventive cardiology. The journal is essential reading for all researchers and clinicians in cardiology.
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