Objective: To determine the influence of patent foramen ovale (PFO) closure on circulatory biomarkers.
Methods: Consecutive patients with PFO-related stroke were prospectively enrolled and followed with serial sampling of cardiac atrial and venous blood pre- and post-PFO closure over time. Candidate biomarkers were identified by mass spectrometry in a discovery cohort first, and lead candidates were validated in an independent cohort.
Results: Patients with PFO-related stroke (n = 254) were recruited and followed up to 4 years (median 2.01; interquartile range 0.77-2.54). Metabolite profiling in the discovery cohort (n = 12) identified homocysteine as the most significantly decreased factor in intracardiac plasma after PFO closure (false discovery rate 0.001). This was confirmed in a validation cohort (n = 181), where intracardiac total homocysteine (tHcy) was immediately reduced in patients with complete closure, but not in those with residual shunting, suggesting association of PFO shunting with tHcy elevation (β 0.115; 95% confidence interval [CI] 0.047-0.183; = 0.001). tHcy reduction was more dramatic in left atrium than right ( < 0.001), suggesting clearance through pulmonary circulation. Long-term effect of PFO closure was also monitored and compared to medical treatment alone (n = 61). Complete PFO closure resulted in long-term tHcy reduction in peripheral blood, whereas medical therapy alone showed no effect (β -0.208; 95% CI -0.375∼-0.058; = 0.007). Residual shunting was again independently associated with persistently elevated tHcy (β 0.184; 95% CI 0.051-0.316; = 0.007).
Conclusions: PFO shunting may contribute to circulatory tHcy elevation, which is renormalized by PFO closure. PFO is not just a door for clots, but may itself enhance clot formation and injure neurovasculature by clot-independent mechanisms. Biomarkers such as tHcy can potentially serve as cost-effective measures of residual shunting and neurovascular risk for PFO stroke.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279569 | PMC |
| http://dx.doi.org/10.1212/WNL.0000000000012188 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Arrhythmias Following Patent Foramen Ovale Closure: An Unsolved Enigma.
Life (Basel)
December 2024
First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece.
Patent foramen ovale (PFO) closure has proven to be an effective method of reducing the risk of recurrent stroke in patients with embolic stroke of unknown origin (ESUS). One of the most recognized post-procedural complications is the de novo occurrence of supraventricular arrhythmias, mainly atrial fibrillation, in the first three months following PFO closure. Earlier studies reported the incidence to be around 3.
View Article and Find Full Text PDFShort-term efficacy of right-to-left shunt closure in patients with vestibular migraine.
Front Neurol
December 2024
Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China.
Objective: This study aims to evaluate the short-term efficacy of right-to-left shunt closure in vestibular migraine patients, and compare the efficacy between patent foramen ovale (PFO) closure and pulmonary arteriovenous malformation (PAVM) embolization. Additionally, the study identifies factors related to surgical outcomes.
Methods: Forty-one patients with vestibular migraine and medium to large right-to-left shunts underwent surgery: PFO closure, PAVM embolization, or both.
Surgical Explantation of an Amplatzer Device for Patent Foramen Ovale Closure in a Patient With Nickel Allergy: A Case Report.
Clin Case Rep
December 2024
Department of Cardiothoracic Surgery HonorHealth Scottsdale Arizona USA.
Patent foramen ovale (PFO) closure using percutaneous devices, such as the Amplatzer occluder, is a common treatment for patients with a history of cryptogenic stroke or transient ischemic attack (TIA). Although generally well-tolerated, some patients may develop adverse reactions to the device materials, particularly in the presence of a nickel allergy. Symptoms can include chest pain, rashes, and migraines, which may necessitate surgical removal of the device.
View Article and Find Full Text PDFThe detailed transseptal puncture technique for optimal closure in patients with a patent foramen ovale.
Front Cardiovasc Med
November 2024
School of Medicine, Atilim University, Ankara, Türkiye.
Background: The closure of a patent foramen ovale (PFO) using transseptal puncture has particular advantages and disadvantages. Thus, transseptal puncture should be re-evaluated in detail.
Aims: We aimed to assess the effectiveness of the detailed transseptal puncture technique in patients who underwent PFO closure due to cryptogenic stroke or transient ischemic attack in terms of residual shunts and atrial fibrillation.
Joint position statement on immersion pulmonary oedema and diving from the South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Diving Medical Committee (UKDMC) 2024.
Diving Hyperb Med
December 2024
TAC Healthcare Group, Wellheads Industrial Estate, Aberdeen, United Kingdom.
This joint position statement (JPS) on immersion pulmonary oedema (IPO) and diving is the product of a workshop held at the 52nd Annual Scientific Meeting of the South Pacific Underwater Medicine Society (SPUMS) from 12-17 May 2024, and consultation with the United Kingdom Diving Medical Committee (UKDMC), three members of which attended the meeting. The JPS is a consensus of experts with relevant evidence cited where available. The statement reviews the nomenclature, pathophysiology, risk factors, clinical features, prehospital treatment, investigation of and the fitness for future compressed gas diving following an episode of IPO.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!