Harm Tobias, Zdanyte Monika, Goldschmied Andreas, Uribe Álvaro Petersen, Reinert Marc, Schreieck Juergen, Aidery Parwez, Rath Dominik, Geisler Tobias, Gawaz Meinrad Paul, Droppa Michal
Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Straße 10, Tübingen, 72076, Germany.
Clin Res Cardiol. 2025 Jul 24. doi: 10.1007/s00392-025-02713-5.
Closure of a patent foramen ovale (PFO) is an effective strategy in the prevention of recurrent stroke after cryptogenic stroke. Residual shunt (RS) is a common issue following PFO closure and may affect safety and efficacy. Transesophageal echocardiography (TEE) is the key diagnostic tool, but standardized assessment of morphological parameters to prevent RS remains challenging.
In this study, we investigate the diagnostic value of different anatomical parameters assessed by TEE to predict RS after PFO closure.
We consecutively enrolled five-hundred and twenty-seven (n = 527) patients undergoing PFO closure. We performed pre-interventional TEE, and after PFO closure, we then screened for RS by TEE at 6-month follow-up.
Pre-interventional TEE measures of PFO morphology revealed significant differences in patients with RS in comparison to those with closed PFO. Incidence of RS was significantly more frequent in patients with atrial septum aneurysm (p = 0.022) and increasing PFO size (p = 0.025). In patients with RS, we found significantly increased length (p = 0.005) of septum primum and PFO tunnel (p = 0.036) as well as excursion (p = 0.005) of septum primum. By training machine learning models on TEE parameters, stratification of PFO morphology resulted in high diagnostic accuracy to predict RS after PFO closure.
Our study elucidates that a baseline characterization of PFO morphology using TEE improves diagnostic precision to identify patients with RS after PFO closure. A standardized approach might thus enhance the efficacy and safety of transcatheter PFO closure. Prediction of complete closure might reduce complications and allow for a more refined patient selection and treatment.
卵圆孔未闭（PFO）封堵是预防隐源性卒中后复发性卒中的有效策略。残余分流（RS）是PFO封堵后的常见问题，可能影响安全性和疗效。经食管超声心动图（TEE）是关键的诊断工具，但对形态学参数进行标准化评估以预防RS仍具有挑战性。
在本研究中，我们调查了通过TEE评估的不同解剖学参数对预测PFO封堵后RS的诊断价值。
我们连续纳入了527例接受PFO封堵的患者。我们在介入治疗前进行了TEE检查，在PFO封堵后，于6个月随访时通过TEE筛查RS。
与PFO已闭合的患者相比，PFO形态的介入治疗前TEE测量结果显示，存在RS的患者有显著差异。房间隔瘤患者（p = 0.022）和PFO尺寸增大（p = 0.025）的患者中RS的发生率明显更高。在存在RS的患者中，我们发现原发隔长度（p = 0.005）、PFO隧道长度（p = 0.036）以及原发隔偏移（p = 0.005）均显著增加。通过基于TEE参数训练机器学习模型，PFO形态分层对预测PFO封堵后RS具有较高的诊断准确性。
我们的研究表明，使用TEE对PFO形态进行基线特征描述可提高诊断精度，以识别PFO封堵后存在RS的患者。因此，标准化方法可能会提高经导管PFO封堵的疗效和安全性。预测完全闭合可能会减少并发症，并有助于更精确地选择患者和进行治疗。
