卵圆孔未闭封堵术治疗先兆偏头痛的疗效异质性分析与预测模型构建OA

Objective:To investigate the differences in therapeutic efficacy of patent foramen ovale(PFO)closure for mi-graine with aura(MA)and develop a multidimensional prediction model integrating clinical,anatomical,and functional charac-teristics to optimize individualized treatment decisions.Methods:This prospective study enrolled 180 MA patients with transthoracic echocardiography(TEE)-confirmed PFO undergoing closure.At 1-year follow-up,patients were divided into an ef-fective group(n=138)and an ineffective group(n=42)based on≥50%reduction in headache impact test-6(HIT-6)and visual analog scale(VAS)scores.Preoperative clinical characteristics,anatomical parameters(PFO,PFO diameter,tunnel length,atrial septal aneurysm(ASA),eustachian valve(EV)/Chiari network(CN)),functional indicators(resting/Valsalva-induced right to left shunt(RLS)grade detection by conventional transthoracic echocardiography(TTE))were compared between groups.Independent predictors were identified through multivariate logistic regression to establish a PFO-migraine response score(PFO-MRS)model,with its discriminative performance validated by ROC curve analysis.Results:The overall effective rate was 76.67%(138/180).Significant intergroup differences(P<0.05)were observed in family history,TTE-detected PFO,PFO diameter>2 mm ASA,EV/CN,and resting RLS≥grade Ⅱ,multivariate regression confirmed these six factors as independent predictors of postoperative migraine improvement.The PFO-MRS model demonstrated 80.42%sensitivity and 73.84%specificity at a cutoff score≥5(AUC=0.813).Conclusion:PFO closure has a significant effect on MA patients with low genetic load(negative family history)and high anatomical-functional load(TTE-detected PFO+PFO>2 mm+ASA+EV/CN+resting RLS≥grade Ⅱ).The PFO-MRS model has shown initial ability to identify potentially beneficial populations.