Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 916-921
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.916
Clinical relevance of atrial septal aneurysm and patent foramen ovale with migraine
Lu He, Ge-Sheng Cheng, Ya-Juan Du, Yu-Shun Zhang
Lu He, Ge-Sheng Cheng, Ya-Juan Du, Yu-Shun Zhang, Department of Structural Heart Disease, Xi’an Jiaotong University Medical College First Affiliated Hospital, Xi’an 710061, Shaanxi Province, China
Author contributions: He L and Zhang YS contributed to conceptualizing and designing the paper; Cheng GS and Du YJ contributed to data analysis and interpretation; He L drafted the article; Cheng GS contributed to critical revision of the article; all authors approved the article.
Institutional review board statement: The study was approved by the ethics committee of Xi’an Jiaotong University Medical College First Affiliated Hospital (Xi’an, China).
Clinical trial registration statement: The clinical trial is registered in ClinicalTrials.gov, using identifier NCT02777359. Details can be found at https://clinicaltrials.gov/ct2/show/NCT02777359?term=NCT02777359&rank=1.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Shun Zhang, MD, PhD, Doctor, Department of Structural Heart Disease, Xi’an Jiaotong University Medical College First Affiliated Hospital, 277 Yanta West Road, Xi’an 710061, Shaanxi Province, China. zys2889@sina.com
Telephone: +86-29-85324078 Fax: +86-29-85324078
Received: July 24, 2018
Peer-review started: July 24, 2018
First decision: October 8, 2018
Revised: October 14, 2018
Accepted: November 7, 2018
Article in press: November 7, 2018
Published online: December 6, 2018
ARTICLE HIGHLIGHTS
Research background

The relationship between patent foramen ovale (PFO) with atrial septal aneurysm (ASA) and migraine remains controversial. We examined this association through an observational, single-center, case-controlled study.

Research motivation

A PFO with ASA has been identified as a risk factor for ischemic stroke. Patients with migraine with aura appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between ASA and migraine in PFO closure patients has rarely been reported. Therefore, in addition to clarifying the relationship between PFO, ASA, and migraine, this study also hopes to provide guidance for the choice of migraine patients who can benefit more from PFO closure.

Research objectives

The research objective of this study was to test the potential association between ASA and migraine in PFO closure patients. Because ASA is a structural abnormality, our findings also verify the role of ASA in migraine with PFO patients. Further PFO and migraine studies should focus on the specific intra-atrial structural abnormality.

Research methods

We retrospectively analyzed 450 migraineurs who had right-to-left shunts and underwent PFO closure from February 2012 to October 2016. The patients were classified into two groups according to whether they had ASA or not: the PFO with ASA group and the PFO without ASA group. This study is a single-center, non-randomized, case-controlled study.

Research results

Our research found that the PFO with ASA patients had an increased frequency of ischemic lesions and migraine with aura. The PFO size was significantly larger in PFO with ASA patients. However, there was no significant difference in Headache Impact Test-6 scores between the PFO with ASA and without ASA groups before and after the PFO closure. Given its nature, the present study shares all of the limitations of case-controlled studies. In our study, the mean follow-up time was only 1 years. Although the effect of PFO closure on migraine usually appears within this time frame, the results may have been affected. The small sample size is another limitation of this study.

Research conclusions

This single-center, case-controlled study cohort, despite its small sample size, suggests that the prevalence of ASA with migraine in PFO patients is associated with ischemic stroke, larger patent foramen ovale size, and migraine with aura. That is to say, the presence/absence of an ASA is associated with differences in baseline characteristics but not with differences in severity of migraine as demonstrated by the similar score results.

Research perspectives

We used the anatomical abnormality of ASA as a breakthrough point, and concluded that patients with ASA have a large PFO diameter and a high incidence of ischemic stroke and migraine with aura. According to our experience, the direction of the future research should focus on the anatomical abnormality of PFO. And we also believe that the highest level of evidence in clinical studies is still a multi-center, prospective, randomized controlled study.