Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Via WA Mozart, 9, Rovigo, 37040, Legnago, Verona, Italy.
Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy.
Int J Cardiovasc Imaging. 2019 Nov;35(11):2049-2056. doi: 10.1007/s10554-019-01666-x. Epub 2019 Jul 19.
Left atrial (LA) enlargement is a marker of LA cardiopathy and, in patients with patent foramen ovale (PFO), is associated with an increased risk of ischemic stroke. The primary study outcome was the comparison of LA diameter between patients undergoing percutaneous PFO closure versus those treated conservatively. The secondary endpoints were the association of LA diameter with the Risk of Paradoxical Emboli (ROPE) score and the presence of Atrial septal aneurysm (ASA) and Right-To-Left Shunt (RLS). Retrospective analysis of clinical and instrumental data of 1040 subjects referred to a single tertiary center for PFO evaluation and treatment. Seven hundred and nineteen patients were enrolled: 495 patients (closure group, mean RoPE score 7.6 ± 0.8) underwent PFO closure while 224 patients (control group, mean RoPE score 4.1 ± 0.9. p < 0.001) were left to medical therapy. Preoperative LA diameter was significantly larger in closure group and reduced from 44.3 ± 9.1 to 37.3 ± 4.1 mm (p = 0.01) 1 year after the procedure to the size of controls. A larger LA diameter was associated with permanent RLS, RLS curtain pattern, ASA presence and multiple ischemic brain lesions pattern at neuroimaging. A LA diameter ≥ 43 mm was a predictor a RoPEscore > 7. In our patients' cohort, LA diameter was associated with the clinic severity of PFO and RLS. The reversal of LA enlargement after PFO closure suggests a role for RLS to induce LA cardiopathy. LA enlargement has the potential to be considered per se as an indication to transcatheter PFO repair.
左心房（LA）扩大是 LA 心脏病的标志物，在卵圆孔未闭（PFO）患者中，与缺血性中风风险增加相关。主要研究结果是比较接受经皮 PFO 封堵术与保守治疗的患者的 LA 直径。次要终点是 LA 直径与反常栓塞风险（ROPE）评分以及房间隔瘤（ASA）和右向左分流（RLS）的关系。对 1040 例因 PFO 评估和治疗而转诊至单一三级中心的患者的临床和仪器数据进行回顾性分析。共纳入 719 例患者：495 例（封堵组，平均 ROPE 评分 7.6±0.8）接受 PFO 封堵，224 例（对照组，平均 ROPE 评分 4.1±0.9，p<0.001）接受药物治疗。封堵组术前 LA 直径明显增大，从 44.3±9.1 降至 1 年后的 37.3±4.1mm（p=0.01），与对照组相同。较大的 LA 直径与永久性 RLS、RLS 幕式、ASA 存在和神经影像学上多发性缺血性脑病变模式相关。LA 直径≥43mm 是 ROPEscore>7 的预测因子。在我们的患者队列中，LA 直径与 PFO 和 RLS 的临床严重程度相关。PFO 封堵后 LA 扩大的逆转表明 RLS 可引起 LA 心脏病。LA 扩大本身可能被视为经导管 PFO 修复的指征。
