Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Jongro-gu, Seoul, Republic of Korea.
Department of Cardiology, Internal Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea.
J Am Soc Echocardiogr. 2023 Aug;36(8):812-820. doi: 10.1016/j.echo.2023.04.010. Epub 2023 Apr 15.
A patent foramen ovale (PFO) can unload left atrial pressure via an interatrial shunt. We investigated whether device closure of PFO is associated with a subsequent risk of heart failure (HF), particularly in patients with structural heart disease or atrial fibrillation (AF).
We enrolled 4,804 consecutive patients who underwent transesophageal echocardiography at tertiary medical centers in Korea between 2007 and 2019. The primary outcome was the 4-year risk of HF hospitalization. Underlying structural heart disease was determined by echocardiography.
A PFO was observed in 981 (20.4%) patients, where 161 underwent device closure. During follow-up (median, 3.5 [1.4-6.4] years), the primary outcome was lower in patients with PFO than in those without (2.6% vs 4.0%; adjusted hazard ratio [aHR], 0.65; 95% CI, 0.45-0.94; P = .021). Among the patients with PFO, the primary outcome was higher in the device closure group than in the no-closure group (5.5% vs 1.2%; aHR, 5.59; 95% CI, 4.26-7.34; P < .001). A consistent result was found in patients with structural heart disease or AF (9.6% vs 3.9%; aHR, 2.55; 95% CI, 1.95-3.33; P < .001), demonstrating an increased risk of the primary outcome proportionate to the number of combined structural abnormalities. However, no significant association was observed between the primary outcome and PFO closure in those without structural heart disease or AF (1.7% vs 1.5%; aHR, 1.22; 95% CI, 0.99-1.50; P = .054).
Patients with underlying structural heart disease or AF may be predisposed to symptomatic HF progression after PFO closure. Therefore, careful medical surveillance with optimal risk management is needed in these patients.
卵圆孔未闭（PFO）可通过房间隔分流来减轻左心房压力。我们研究了 PFO 的器械封堵是否与心力衰竭（HF）风险增加相关，尤其是在结构性心脏病或心房颤动（AF）患者中。
我们纳入了 2007 年至 2019 年期间在韩国三级医疗中心接受经食管超声心动图检查的 4804 例连续患者。主要结局是 4 年 HF 住院风险。结构性心脏病通过超声心动图确定。
981 例（20.4%）患者存在 PFO，其中 161 例行器械封堵。在随访期间（中位数 3.5 [1.4-6.4] 年），PFO 患者的主要结局低于无 PFO 患者（2.6% vs 4.0%；调整后的危险比 [aHR]，0.65；95%CI，0.45-0.94；P=0.021）。在存在 PFO 的患者中，器械封堵组的主要结局高于未封堵组（5.5% vs 1.2%；aHR，5.59；95%CI，4.26-7.34；P<0.001）。在结构性心脏病或 AF 患者中也得到了一致的结果（9.6% vs 3.9%；aHR，2.55；95%CI，1.95-3.33；P<0.001），主要结局的风险随着合并结构性异常数量的增加而增加。然而，在无结构性心脏病或 AF 的患者中，主要结局与 PFO 封堵之间无显著相关性（1.7% vs 1.5%；aHR，1.22；95%CI，0.99-1.50；P=0.054）。
患有结构性心脏病或 AF 的患者在 PFO 封堵后可能更容易出现症状性 HF 进展。因此，这些患者需要仔细的医疗监测和最佳的风险管理。
