Abstract TP430: Plasma Proteomic Changes Persist in Long Term Follow-up of Patent Foramen Ovale Related Stroke Patients after PFO Closure

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
MingMing Ning ◽  
Mary Lopez ◽  
David A Sarracino ◽  
Kathleen Feeney ◽  
Molly Thayer ◽  
...  
Keyword(s):  
Therapeutic Efficacy ◽  
Patent Foramen Ovale ◽  
Venous Blood ◽  
Disease Process ◽  
Foramen Ovale ◽  
Proteomic Profiling ◽  
Proteomic Approach ◽  
Individualize Treatment ◽  
Pfo Closure

Introduction: Paradoxical embolism from patent foramen ovale (PFO), a heterogeneous multi-organ condition involving brain, lung, heart and blood, lacks consensus for treatment options due to variability among individual patients. Clinical proteomic approaches may be promising for such complex diseases, where the disease process can be monitored in clinically accessible fluid such as blood. Here, we apply a pharmaco-proteomic approach to study PFO endovascular closure, an intervention that requires better risk stratification and monitoring of therapeutic efficacy to individualize treatment. Previously, we found that plasma small molecule signals such as serotonin, TSP-1 and microparticles -- which may avoid pulmonary filtration via PFO -- decrease immediately in the systemic circulation after effective PFO closure. Now we study the long-term effect of PFO endovascular closure. Methods/Results: To reduce confounders in an inherently complex system, the most robust clinical proteomic comparisons are those of profiles taken over time from the same individual. Accordingly, in consecutively recruited patients who underwent PFO closure (n=37), we analyze venous blood obtained prior to closure and in long-term followup (1-3 yrs) post closure. None of the subjects experienced recurrent TIA or strokes. More than 1 year post closure, plasma protein profiles -- in addition to the persistent decrease in small molecules such as serotonin -- continue to show a statistically significant (p<0.05) decrease of coagulation markers such as fibrinogen, fibrinogen fragments, D-dimer and others. Moreover, markers of inflammatory changes such as hsCRP, apolipoproteins and various immunoglobulins also remain decreased. Conclusion: A pharmaco-proteomic approach is clinically feasible and may help to monitor therapeutic efficacy, improve patient selection, and ensure more precise clinical phenotyping for clinical trials in PFO-related stroke. More than 1 year post PFO closure, relevant inflammatory and coagulation factors remain lowered after adjusting for other confounders such as medication changes. Further studies are needed to explore the utility of proteomic profiling to help individualize treatment in PFO-related strokes.

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

Neurology ◽  
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.

scholarly journals Short- and long-term haemodynamic consequences of transcatheter closure of atrial septal defect and patent foramen ovale

2021 ◽  
Author(s):  
X. Jin ◽  
Y. M. Hummel ◽  
W. T. Tay ◽  
J. F. Nauta ◽  
N. S. S. Bamadhaj ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Diastolic Function ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Foramen Ovale ◽  
Short And Long Term ◽  
Interatrial Shunt ◽  
Pfo Closure

Abstract Background Transcatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure might have opposite short- and long-term haemodynamic consequences compared with restricted interatrial shunt creation, which recently emerged as a potential treatment modality for patients with heart failure with preserved ejection fraction (HFpEF). Given the opposing approaches of ASD and PFO closure versus shunt creation, we investigated the early and sustained cardiac structural and functional changes following transcatheter ASD or PFO closure. Methods In this retrospective study, adult secundum-type ASD and PFO patients with complete echocardiography examinations at baseline and at 1‑day and 1‑year follow-up who also underwent transcatheter closure between 2013 and 2017 at the University Medical Centre Groningen, the Netherlands were included. Results Thirty-nine patients (mean age 48 ± standard deviation 16 years, 61.5% women) were included. Transcatheter ASD/PFO closure resulted in an early and persistent decrease in right ventricular systolic and diastolic function. Additionally, transcatheter ASD/PFO closure resulted in an early and sustained favourable response of left ventricular (LV) systolic function, but also in deterioration of LV diastolic function with an increase in LV filling pressure (LVFP), as assessed by echocardiography. Age (β = 0.31, p = 0.009) and atrial fibrillation (AF; β = 0.24, p = 0.03) were associated with a sustained increase in LVFP after transcatheter ASD/PFO closure estimated by mean E/e’ ratio (i.e. ratio of mitral peak velocity of early filling to diastolic mitral annular velocity). In subgroup analysis, this was similar for ASD and PFO closure. Conclusion Older patients and patients with AF were predisposed to sustained increases in left-sided filling pressures resembling HFpEF following ASD or PFO closure. Consequently, these findings support the current concept that creating a restricted interatrial shunt might be beneficial, particularly in elderly HFpEF patients with AF.

scholarly journals Long-Term Outcome Following Patent Foramen Ovale (PFO) Closure

2017 ◽  
Vol 26 ◽  
pp. S215-S216
Author(s):  
K. Balakrishnan ◽  
G. Koshy ◽  
B. Thompson ◽  
B. Herman
Keyword(s):  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pfo Closure

Abstract 4513: Efficacy And Safety Of Percutaneous Patent Foramen Ovale Closure In Patients With Thrombophilia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Pablo Rengifo-Moreno ◽  
Ignacio Cruz-Gonzalez ◽  
Roberto J Cubeddu ◽  
Maria Sanchez-Ledezma ◽  
Mingming Ning ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Rank Test ◽  
Foramen Ovale ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cerebral Ischemic ◽  
Pfo Closure

Background: The presence of a patent foramen ovale (PFO) is associated with higher rates of cryptogenic stroke. In patients with hypercoagulable states, the incidence of recurrent cerebral ischemic events may be greatly increased if a PFO is present. Percutaneous PFO closure is an alternative therapeutic approach for patients with both conditions who are not candidates for long-term anticoagulation, or have developed recurrent neurological events despite medical therapy. Methods: Between January 1995 to February 2007, 424 consecutive patients with PFO and cryptogenic stroke underwent percutaneous PFO closure. Of these, we identified 112 (26%) patients with a hypercoagulable disorder. We compared the safety and long-term outcome of percutaneous PFO closure in these two groups of patients. Results: Patients with thrombophilia were older (51.7±13 vs 48.3±14 years, p = 0.025), yet no different regarding baseline demographics or echocardiographic characteristics. Percutaneous PFO closure was successful in all the patients. There were no differences in the type of device used (Amplatzer: 53.6 vs 50%, Cardioseal 39.3 vs 41.7%, Sideris 7.1 vs 8.3%; p= 0.78). At median follow-up of 14.3 months (interquartile range: 6.1–31.4 months) there rate of stroke/TIA was similar for both groups (1.7 vs 1.6%, log rank test p = 0.35). At follow-up echocardiography, the rate of complete PFO closure was greater in the thrombophilic patients (97.3 vs 91.7%, p=0.04). Conclusions: Percutaneous PFO closure is safe and effective in preventing recurrent ischemic cerebral events in patients with thrombophilia.

Percutaneous closure of patent foramen ovale for the secondary prevention of decompression illness in sports divers: mind the gap

2019 ◽  
pp. 625-632
Author(s):  
Martin Vanden Eede ◽  
◽  
An Van Berendoncks ◽  
Daniel De Wolf ◽  
Catherine De Maeyer ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Patent Foramen Ovale ◽  
Decompression Illness ◽  
Foramen Ovale ◽  
Tertiary Referral Center ◽  
Scuba Divers ◽  
Procedural Complications ◽  
History Of ◽  
Pfo Closure

Objective: To evaluate the efficiency of percutaneous patent foramen ovale (PFO) closure on the recurrence of decompression illness (DCI). Design: Retrospective, observational study with interview and questionnaire Setting: Tertiary referral center. Population: 59 scuba divers with a history of DCI who received a percutaneous PFO closure. Main outcome measurements: Questionnaire about health status, dive habits and recurrence of DCI after PFO closure. Results: A total of 59 divers with DCI were included. The most common manifestations of DCI were cutaneous or vestibular DCI. Procedural complications occurred in four patients but none with long-term consequences. Four patients had recurrence of DCI after closure during a 10-year follow-up. In three of these cases there was residual shunting, all of which were initially considered closed. The fourth patient had aggravating factors for his recurrent DCI. A quarter of the patients stated to have changed their diving habits. Four patients quit diving. Conclusion: Percutaneous PFO closure for secondary prevention of DCI is associated with few, but not negligible, complications. As a large portion of our cohort changed their diving habit after closure it is difficult to ascertain the efficiency of PFO closure for secondary prevention of DCI. However, the study shows that PFO closure does not fully protect against DCI, emphasizing that the relationship between PFO and DCI is but an association. As such it is imperative that divers be counseled to ensure they understand the risks as well as the benefits of percutaneous PFO closure in their specific case.

P3710Long term follow-up in a real-world study cohort after patent foramen ovale closure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Hamm ◽  
O Doerr ◽  
M Haas ◽  
L Schulz ◽  
T Koerschgen ◽  
...  
Keyword(s):  
Real World ◽  
Patent Foramen Ovale ◽  
Recurrent Stroke ◽  
Controlled Trials ◽  
Foramen Ovale ◽  
Randomized Controlled ◽  
Cerebrovascular Occlusive Disease ◽  
Pfo Closure

Abstract Background Patent foramen ovale (PFO) closure is the treatment of choice after cryptogenic stroke according recent evidence. The indication is based on results of several randomized controlled trials; however, the results of these trials may not be extrapolated to a real-world clinical setting. Therefore, the aim of the present study was to evaluate long-term outcome regarding recurrent stroke, migraine, and/or peripheral embolism in patients after PFO closure. Methods We retrospectively analyzed outcomes of consecutive patients undergoing PFO closure from 2011 to 2018 at two interventional sites with respect to periprocedural events occurring during hospitalization and long-term follow-up. Follow-up data were collected from outpatient visits or telephone interviews. Results The analysis included 214 consecutive patients (mean age 52 years; 58% male). The follow-up rate was 96% and the mean follow-up time was 38 (SD 22) months. The index vascular event leading to PFO closure was stroke (n=190; 89%), including patients with repetitive stroke (n=36), embolic myocardial infarction (n=21), and migraine (n=3). One quarter (24.6%) of the population studied had an atrial septal aneurysm (>15 mm). Procedural success was achieved in 98%. There were no procedure-related strokes or deaths. Periprocedural complications occurred in 16 patients (7%): two cases of pericardial tamponade, seven complications at the access site mainly caused by bleeding, two cases of transient atrial fibrillation, and five other complications. The Amplatz Septal Occluder™ was used in two thirds (64.5%) of the cases and the Gore Cardioform™ device in one third (28.6%). Four (2%) patients died during follow-up. None of these patients experienced a recurrent stroke. Ten (5%) other patients experienced a recurrent stroke. Patients with recurrent stroke events were older than patients without recurrent stroke (mean 62.6 [SD 8.8] years vs. mean 52.2 [SD 13.8] years; p=0.015) and had a higher rate of preexisting cerebrovascular occlusive disease (5 [50%] vs. 10 [6%]; p<0.0001). There was no difference in risk for recurrent stroke between patients with one prior stroke and more than one stroke before PFO closure (p=0.71). Atrial fibrillation occurred in 6.6% of the patients during follow-up, but only one of these patients had recurrent stroke. No other anatomic and vascular risk factors or antithrombotic treatments were identified as being predictive of embolic events after closure. Conclusion In this real-world PFO closure cohort the recurrent stroke rate is low, although it is higher than reported in the recent randomized controlled trials. Recurrent strokes after PFO closure may reflect additional comorbid risk factors such as age or cerebrovascular occlusive disease that are unrelated to the potential for paradoxical embolism.

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

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.

Abstract T P114: Effect Endovascular Closure Procedure on the Quality of Life in Stroke Patients with Patent Foramen Ovale

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kathleen Feeney-Heinzelmann ◽  
Wenjun Deng ◽  
Thomas Wickham ◽  
Mikaela Elia ◽  
Ignacio Inglessis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patent Foramen Ovale ◽  
Stroke Severity ◽  
Depression And Anxiety ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Stroke Risk Factor ◽  
Pfo Closure

Introduction: Patent foramen ovale (PFO), an opening between the left and right atria, is an independent stroke risk factor associated with more than 150,000 strokes per year in the US. PFO stroke patients tend to be younger - most are of child bearing age, enjoy an active lifestyle and are a major component of the work force, who are not long-term anticoagulant candidates. While trials are ongoing to compare closure vs medical treatment, younger stroke patients tend to prefer endovascular closure rather than long-term anticoagulation. Here we investigate the effect of PFO closure for stroke prevention on patients’ quality of life. Methods: Patients were recruited per IRB-approved protocol from the MGH Cardio-Neurology Clinic. To quantify the effect of PFO closure on depression and anxiety, validated Becks Depression and Anxiety Inventory were performed by research nurses at 3 months before and 3-6 months after PFO closure. Clinical data on stroke severity, outcome and blood samples were also collected. Results: 32 consecutive PFO stroke patients, adjudicated by two vascular neurologists (average age 50.75, range 22-59; 56% male) were enrolled. No new treatments (e.g. anti-depressant/anti-anxiety meds) were initiated during the study. After successful PFO closure, patients had significantly improved anxiety (3 vs 5.75, p= 0.043) and depression scores (2.58 vs 3, p= 0.05) (Figure). Cortisol level also lowered post PFO closure (data not shown due to space). Conclusion: PFO stroke patients have improved quality of life after PFO closure as measured by validated quantitative anxiety and depression scales under the care of a team of nurses, physicians and neuropsychologist. These findings demonstrate the importance of a multi-disciplinary approach to stroke patient care, and also the effect of endovascular closure in improving the quality of life in younger stroke patients. Future studies are needed in a larger cohort with long term follow-up to validate these results.

Abstract WP419: Long-term Risk of Complications after Endovascular Closure of Patent Foramen Ovale

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Shadi Yaghi ◽  
Peter M Okin ◽  
Costantino Iadecola ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Infective Endocarditis ◽  
Ventricular Arrhythmia ◽  
Patent Foramen Ovale ◽  
Administrative Claims ◽  
Foramen Ovale ◽  
Cumulative Rate ◽  
Pfo Closure

Background: The long-term safety of patent foramen ovale (PFO) closure following stroke or transient ischemic attack (TIA) is uncertain. We sought to evaluate the long-term risk of complications following endovascular PFO closure in a large, heterogeneous group of patients with cerebrovascular disease. Methods: We performed a retrospective cohort study using administrative claims data on all acute care hospitalizations from 2005-2011 in California, 2006-2013 in New York, and 2005-2013 in Florida. Using ICD-9-CM codes, we identified patients without other forms of congenital heart disease who underwent endovascular PFO closure within 1 year of a stroke or TIA. The primary outcome was a serious complication, defined as in prior studies as atrial fibrillation, cardiac tamponade, pneumothorax, hemothorax, a vascular access complication, or death. Kaplan-Meier survival analysis was used to calculate the cumulative rate of complications. In a secondary analysis, we included other serious complications described in previous randomized trials of PFO closure after stroke: venous thromboembolism, ventricular arrhythmia, infective endocarditis, and sepsis. Results: We identified 1,887 patients who underwent PFO closure after stroke or TIA, among whom the mean age at the time of closure was 54.2 (±14.3) years. By 7 years, the cumulative rate of any complication or death was 18.3% (95% confidence interval [CI], 15.9-21.0%). The mortality rate was 3.4% (95% CI, 2.5-4.6%). Atrial fibrillation was the most common complication, occurring in 8.3% (95% CI, 7.1-9.5%) of patients. The rate of any complication during the index hospitalization for PFO closure was 7% (95% CI, 5.8-8.1%). When venous thromboembolism, ventricular arrhythmia, infective endocarditis, and sepsis were included, the cumulative rate of any complication or death throughout follow-up was 21.4% (95% CI, 19.0-24.0%). Conclusions: Approximately 1 in 5 patients who undergo PFO closure after stroke or TIA experience a serious complication or death within 7 years.

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