15: PFO CLOSURE REDUCES PLASMA LEVELS OF SEROTONIN IN A LONG TERM FOLLOWUP OF STROKE PATIENTS

Purpose of StudyPFO allows venous clots and vasoactive factors to bypass pulmonary filtration and remain in circulation. We previously identified an immediate reduction of procoagulant serotonin (5-HT) in left atrial blood post PFO closure. To understand the long-term effect of PFO closure, we report the change of 5-HT in peripheral venous blood in 1-year followup.Methods Used97 PFO-related stroke patients were recruited on IRB approval. Venous blood was collected at baseline (BL) and 1 year follow-up (FU) of treatments (PFO closure and medical therapy). Plasma 5-HT was quantified by mass spectrometry. Patients with serotonin modifying medications (ie. SSRIs) or conditions (anxiety/depression) were excluded.Summary of Results5-HT level in peripheral venous blood was significantly reduced by 27.27% (BL: 7.57±8.04 µM; FU: 5.51±5.72 µM; p=0.0034) in 61 patients receiving PFO closure (figure 1A). In the 37 PFO patients treated with medicine alone, no changes were observed (BL: 5.79±7.15 µM; FU: 6.25±6.68 µM; p=0.4050) (figure 1B). 5-HT reduction was independently associated with PFO closure after adjusting for age, gender, medical history and medication status in a multivariate regression (figure 1C).ConclusionsWe found that PFO closure independently reduced 5-HT level in peripheral venous blood. These results support the hypothesis that PFO related right-to-left interatrial shunt may foster higher level of procoagulant and vascoactive substances in circulation. While PFO closure decrease prothrombotic markers immediately post closure, this effect is sustained in long term followup up to 1 year. Further studies on the clinical outcome of these PFO patients with respect to their prothrombotic circulatory profiles are ongoing.Abstract 15 Figure 1

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Abstract TP426: PFO Closure Reduces Plasma Levels of Serotonin in Long Term Follow up of Stroke Patients

Stroke ◽

10.1161/str.47.suppl_1.tp426 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Wenjun Deng ◽

David McMullin ◽

Thomas Wickham ◽

Kathleen Feeney ◽

Ignacio Inglessis ◽

...

Keyword(s):

Medical Therapy ◽

Venous Blood ◽

Stroke Patients ◽

Peripheral Venous Blood ◽

Vasoactive Substances ◽

Long Term Effect ◽

Long Term Follow Up ◽

Pfo Closure

Background: PFO allows venous clots and vasoactive circulatory factors to bypass pulmonary filtration and remain in circulation. Serotonin (5-HT) has procoagulant and oxidative roles in both cardiovascular and neurovascular injury. We previously identified an immediate reduction of 5-HT in left atrial blood post PFO closure. To understand the long-term effect of PFO closure, we report the changes of 5-HT in peripheral venous blood in 1-year follow-up. Method: 97 PFO-related stroke patients were recruited in accordance with IRB. Venous blood was collected at baseline (BL) and 1 year follow-up (FU) post treatment (PFO closure or medical therapy). Plasma 5-HT was quantified by mass spectrometry. Patients with serotonin modifying medications (e.g. SSRIs) or conditions (e.g. anxiety/depression) were excluded. Result: 5-HT concentration in peripheral venous blood was significantly reduced by 27.27% (BL: 7.57 ± 8.04 μmol/l; FU: 5.51 ± 5.72 μmol/l; p = 0.0034) in 61 patients receiving PFO closure (Fig 1A). In the 37 PFO patients treated with medical therapy alone, no changes were observed (5-HT: BL: 5.79 ± 7.15 μmol/l; FU: 6.25 ± 6.68 μmol/l; p = 0.4050) (Fig 1B). This decrease in serotonin was independently associated with PFO closure after adjusting for age, gender, medical history and medication status in a multivariate regression (Fig 1C). Conclusion: We found that PFO closure independently reduced 5-HT level in peripheral venous blood. These results support the hypothesis that PFO associated right-to-left interatrial shunting may foster higher levels of procoagulant and vasoactive substances in circulation. We have previously found PFO closure to decrease prothrombotic markers immediately post closure; this effect is now shown also to be sustained in long term follow-up up to 1 year. Further studies are ongoing on the clinical outcome of these PFO related stroke patients with respect to their prothrombotic circulatory profiles.

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Effect of Patent Foramen Ovale (PFO) Closure After Stroke on Circulatory Biomarkers

Neurology ◽

10.1212/wnl.0000000000012188 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012188

Author(s):

Wenjun Deng ◽

David McMullin ◽

Ignacio Inglessis-Azuaje ◽

Joseph J. Locascio ◽

Igor F. Palacios ◽

...

Keyword(s):

Patent Foramen Ovale ◽

Venous Blood ◽

Cost Effective ◽

Foramen Ovale ◽

Stroke Patients ◽

Discovery Cohort ◽

Long Term Effect ◽

Serial Sampling ◽

Pfo Closure

Objective:To determine the influence of patent foramen ovale (PFO) closure on circulatory biomarkers.Methods:Consecutive PFO-related stroke patients 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:PFO stroke patients (n=254) were recruited and followed up to four years (median: 2.01; IQR: 0.77∼2.54). Metabolite profiling in discovery cohort (n=12) identified homocysteine as the most significantly decreased factor in intra-cardiac plasma after PFO closure (FDR=0.001). This was confirmed in validation cohort (n=181), where intra-cardiac total homocysteine (tHcy) reduced immediately in patients with complete closure, but not in those with residual shunting, suggesting association of PFO shunting with tHcy elevation (β: 0.115; 95% CI: 0.047∼0.183; p=0.001). tHcy reduction was more dramatic in left atrium than right (p<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; p=0.007). Residual shunting was again independently associated with persistently elevated tHcy (β: 0.184; 95% CI: 0.051∼0.316; p=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.

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Efficacy of patent foramen ovale closure for treating migraine: a prospective follow-up study

Journal of Investigative Medicine ◽

10.1136/jim-2020-001323 ◽

2020 ◽

Vol 69 (1) ◽

pp. 7-12

Author(s):

Yi Qi ◽

Yushun Zhang ◽

Xiaohui Luo ◽

Gesheng Cheng ◽

Yajuan Du ◽

...

Keyword(s):

Clinical Outcomes ◽

Patent Foramen Ovale ◽

Foramen Ovale ◽

Residual Shunt ◽

Vas Score ◽

Long Term Effect ◽

The Difference ◽

Pfo Closure

This study aims to evaluate the potential of percutaneous patent foramen ovale (PFO) closure to improve the headache in patients with migraine and PFO, and discuss the difference between the randomized controlled trials (RCTs) and the single-center studies. Patients of migraine with a large shunt of PFO, who experienced ≥2 headache attacks per month and failed ≥2 categories of standardized medication, underwent PFO closure in First Affiliated Hospital of Xi'an Jiao Tong University. The clinical outcomes, including frequency and duration of headache attacks, Headache Impact Test (HIT-6) score, and Visual Analogue Scale (VAS) score, were evaluated at 3, 6, and 12 months of follow-up after the PFO closure. The different efficacies of the clinical outcomes between patients with and without aura as well as different grades of PFO were also evaluated, respectively. 134 patients with migraine (39 male and 95 female) with PFO were enrolled, whose average age was 39.21±11.37 years. After PFO closure, there was a significant reduction in frequency and duration of headache attacks, HIT-6 score, and VAS score at 3, 6, and 12 months’ follow-up (p<0.001). Migraine was completely relieved in 54 (40.30%) patients during 12 months’ follow-up. The frequency of migraine was reduced by >50% in 44 (32.84%) patients at 3 months’ follow-up and increased to 48 (35.82%) at 12 months’ follow-up. 31.03% patients remained residual shunt after 6 months of closure with varying improvements of headache. This study confirmed that PFO closure can effectively reduce frequency and duration of migraine and improve quality of life, but the definitive indications and long-term effect still need further research.

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Faculty Opinions recommendation of Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.6869957.7111059 ◽

2010 ◽

Author(s):

Ellen Chang ◽

Daphne Lichtensztajn

Keyword(s):

Colorectal Cancer ◽

Cancer Incidence ◽

Term Effect ◽

Randomised Trials ◽

Long Term Effect ◽

Incidence And Mortality ◽

Colorectal Cancer Incidence

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Lichtenstein inguinal hernia repairs with porcine small intestine submucosa: a 5- year follow-up. a prospective randomized controlled study

Regenerative Biomaterials ◽

10.1093/rb/rbaa055 ◽

2021 ◽

Author(s):

Baoshan Li ◽

Xin Zhang ◽

Yi Man ◽

Jiadong Xie ◽

Wei Hu ◽

...

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Term Effect ◽

Control Group ◽

Small Intestine Submucosa ◽

Long Term Effect ◽

Porcine Small Intestine Submucosa

Abstract Porcine small intestine submucosa (SIS) biologic patch has been used in inguinal hernia repair. However, there are little data available to assess the long-term effect after repair. This study aimed to explore the long-term effect of SIS patch in open inguinal hernia repair. Sevent-six patients with unilateral inguinal hernia were treated with Lichtenstein tension-free hernia repair using SIS patch (Beijing Datsing Bio-Tech Co., Ltd.) and Surgisis patch (COOK, USA) in Tianjin Union Medical Center and China-Japan Friendship Hospital. In the trial, the long-term efficacy of the treatment group and the control group were compared. A total of 66 patients in both groups received long-term follow-up (> 5 years) after surgery, with a follow-up rate of 86.8%. During the follow-up period, there was one case of recurrence, one case of chronic pain in the control group. There was no statistically significant difference (P > 0.05) in terms of recurrence, chronic pain, foreign body sensation and infection between the two groups of patients. After long-term observations, it has been found that the porcine small intestinal submucosa (SIS) biological patch is safe and effective for inguinal hernia Lichtenstein repair, and has a low recurrence rate and complication rate.

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Long-Term Evaluation of the Roux-Elmslie-Trillat Procedure for Patellar Instability

The American Journal of Sports Medicine ◽

10.1177/0363546504272686 ◽

2005 ◽

Vol 33 (8) ◽

pp. 1220-1223 ◽

Cited By ~ 57

Author(s):

Joseph R. Carney ◽

Timothy S. Mologne ◽

Michael Muldoon ◽

Jay S. Cox

Keyword(s):

Confidence Interval ◽

Case Series ◽

Level Of Evidence ◽

Long Term Effect ◽

Functional Scores ◽

Study Population ◽

Term Evaluation ◽

Subluxation Of The Patella

Background Few published articles exist reporting the long-term evaluation of the Roux-Elmslie-Trillat procedure. Purpose To assess the long-term effect of the Roux-Elmslie-Trillat procedure in preventing recurrent subluxation and dislocation of the patella. Study Design Case series; Level of evidence, 4. Methods Eighteen patients who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella were identified from a group previously evaluated at a mean follow-up of 3 years. The prevalence of recurrent subluxation or dislocation at a mean follow-up of 26 years was compared with the prevalence reported at the mean follow-up of 3 years. Although not the focus of this study, Cox functional scores were obtained from the smaller group and compared with the results at the 3-year follow-up. Results Seven percent (95% confidence interval, 0.00-0.32) of the patients had recurrent subluxation at 26 years compared with 7% (95% confidence interval, 0.03-0.13) of the study population reported at 3 years (P = 1.00). Fifty-four percent (95% confidence interval, 0.27-0.79) rated their affected knee as good or excellent at 26 years compared with 73% (95% confidence interval, 0.64-0.81) of the larger study population reported at 3 years (P = .14). Conclusion The prevalence of recurrent subluxation and dislocation in patients with patellofemoral malalignment who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella is similar at 3 and 26 years after the procedure. The long-term functional status of the affected knee in patients who underwent the Roux-Elmslie-Trillat procedure declined.

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Long-Term Effect of Endoscopic Sympathetic Nerve Reconstruction for Side Effects after Endoscopic Sympathectomy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1582431 ◽

2016 ◽

Vol 65 (06) ◽

pp. 484-490 ◽

Cited By ~ 3

Author(s):

Timo Telaranta ◽

Tuomo Rantanen

Keyword(s):

Side Effects ◽

Sympathetic Nerve ◽

Nerve Reconstruction ◽

Endoscopic Thoracic Sympathectomy ◽

Thoracic Sympathectomy ◽

Long Term Effect ◽

Primary Hyperhidrosis ◽

The Mean

Background Endoscopic thoracic sympathectomy (ETS) is an effective treatment for primary hyperhidrosis. However, compensatory sweating (CS) may occur in many patients. Sympathetic nerve reconstruction (SNR) can be used to counteract severe CS, but the studies on the effects of SNR are few. Patients and Methods Nineteen out of 150 SNR patients were contacted by employing a long-term questionnaire. In this questionnaire, different kinds of sweating were evaluated using a four-graded symptom analysis and the visual analog scale before ETS, after ETS, and after SNR. Results The mean age of the 16 male and 3 female patients at the SNR was 32 years. The mean follow-up was 87 months. According to the long-term questionnaire, the benefit was either excellent (4 patients, 21%), good (3 patients, 15.8%), or reasonable (7 patients, 36.8%) in 14 patients (73.8%), while the benefit was questionable in 1 patient (5.3%). For three patients (15.8%), no benefit was found, and in one patient (5.3%), the situation had deteriorated. Conclusions Improvement in the side effects of ETS after SNR was found in nearly 75% of the patients. This indicates that SNR can be considered as an alternative treatment for patients with severe CS after ETS that is unresponsive to conservative treatment.

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Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽

10.1161/str.45.suppl_1.176 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Tae-Jin Song ◽

Jinkwon Kim ◽

Dongbeom Song ◽

Yong-Jae Kim ◽

Hyo Suk Nam ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Independent Predictor ◽

Stroke Patients ◽

Risk Of Death ◽

Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

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