Chen Chunyu, Liu Li, Zhang Yonghua, Chen Dan, Chen Yuyi, Qu Lulu, Su Xi, Chen Yanhong
Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei Province, 430022, China.
Department of Cardiology, The Second Affiliated Hospital of Wuhan University, Zhongnan Hospital, Wuhan, Hubei Province, 430060, China.
Heliyon. 2024 Nov 8;10(22):e40248. doi: 10.1016/j.heliyon.2024.e40248. eCollection 2024 Nov 30.
Both atrial fibrillation (AF) and patent foramen ovale (PFO) has been associated with occurrences of ischemic stroke. The aim of this study was to investigate whether patients with concomitant AF and PFO were at an increased risk of stroke, and whether PFO closure was necessary for the prevention of stroke in AF patients who underwent left atrial appendage closure (LAAC).
We retrospectively analyzed 614 patients who underwent LAAC at Wuhan Asia Heart Hospital from May 2014 to April 2021. We compared the baseline clinical characteristics and ischemic stroke rates before LAAC, major adverse cardiovascular events (MACEs) and other long-term outcomes between AF patients with and without PFO after LAAC. The predictor for ischemic stroke or TIA after LAAC was analyzed with univariate and multivariable Cox regression, and the long-term cumulative survival rates of AF patients with PFO compared to those without PFO after LAAC were analyzed with the Kaplan-Meier graph.
A total of 614 patients who underwent LAAC and had completed follow-up data were included in our study. Among them, 74 patients were diagnosed with AF with PFO, and 540 with AF without PFO. There was no significant difference between their baseline clinical data, including ischemic stroke rates (p = 0.961). Patients with and without PFO had similar device implantation success rates (98.6 % vs 99.4 %, = 0.403) and procedure-related complications. During follow-up (medium follow-up period 36.9 months), no significant difference was observed in the incidence of MACEs (8.1 % in PFO group vs 5.7 % in non-PFO group, = 0.432) or the cumulative ischemic stroke/TIA rates (5.4 % in PFO group vs 4.3 % in non-PFO group, = 0.554). The Cox multivariable regression analysis indicated that the presence of PFO in patients with AF had no correlation with ischemic stroke or TIA after LAAC implantation (HR 1.685, 95 % CI 0.570-4.978, = 0.345). The only predictor for ischemic stroke/TIA events after LAAC was major leakage (>5 mm) seen on transesophageal echocardiography (TEE) or left atrial CTA at the 45-day follow-up (HR 10.352, 95 % CI 1.221-87.736, = 0.032).
AF patients with PFO are not at increased risk for ischemic stroke or TIA before LAAC. The presence of PFO in AF patients did not affect the success rate and safety of LAAC. The presence of mild PFO is not a viable predictor of stroke events in AF patients who underwent LAAC during long-term follow-up. Major leakage (>5 mm) is associated with a higher ischemic stroke/TIA rate in AF patients who underwent LAAC.
心房颤动（AF）和卵圆孔未闭（PFO）均与缺血性卒中的发生有关。本研究旨在探讨合并AF和PFO的患者是否具有更高的卒中风险，以及对于接受左心耳封堵术（LAAC）的AF患者，封堵PFO是否对预防卒中是必要的。
我们回顾性分析了2014年5月至2021年4月在武汉亚洲心脏病医院接受LAAC的614例患者。我们比较了LAAC术前AF合并PFO患者与不合并PFO患者的基线临床特征和缺血性卒中发生率、主要不良心血管事件（MACE）及其他长期结局。采用单因素和多因素Cox回归分析LAAC术后缺血性卒中或短暂性脑缺血发作（TIA）的预测因素，并用Kaplan-Meier曲线分析LAAC术后合并PFO与不合并PFO的AF患者的长期累积生存率。
本研究共纳入614例接受LAAC且有完整随访数据的患者。其中，74例被诊断为AF合并PFO，540例为AF不合并PFO。他们的基线临床数据，包括缺血性卒中发生率，差异无统计学意义（p = 0.961）。合并和不合并PFO的患者在器械植入成功率（98.6%对99.4%，p = 0.403）和手术相关并发症方面相似。随访期间（中位随访期36.9个月），MACE发生率（PFO组为8.1%，非PFO组为5.7%，p = 0.432）或累积缺血性卒中/TIA发生率（PFO组为5.4%，非PFO组为4.3%，p = 0.554）差异均无统计学意义。Cox多因素回归分析表明，AF患者合并PFO与LAAC植入术后缺血性卒中或TIA无关（HR 1.685，95%CI 0.570 - 4.978，p = 0.345）。LAAC术后缺血性卒中/TIA事件的唯一预测因素是在45天随访经食管超声心动图（TEE）或左心房CTA检查时发现的严重渗漏（>5 mm）（HR 10.352，95%CI 1.221 - 87.736，p = 0.032）。
AF合并PFO患者在LAAC术前发生缺血性卒中或TIA的风险并未增加。AF患者合并PFO不影响LAAC的成功率和安全性。轻度PFO的存在并非LAAC术后AF患者长期随访中卒中事件的有效预测指标。严重渗漏（>5 mm）与接受LAAC的AF患者更高的缺血性卒中/TIA发生率相关。
