Association between patent foramen ovale and chronic obstructive pulmonary disease: A systematic review and meta-analysis.

BACKGROUND

Patent foramen ovale (PFO) is a defect in the intra-atrial septum that occurs when the foramen ovale does not close postnatally. Chronic obstructive pulmonary disease (COPD) is a respiratory condition that causes airflow obstruction.

OBJECTIVE

This systematic review aimed to consolidate current evidence on the association between PFO and COPD outcomes.

METHODS

We searched Medline, Embase, and Cochrane databases from inception to November 2023 for studies conducted among adults who have been diagnosed with COPD and underwent testing for PFO. A structured data extraction sheet was created to collect data from selected studies. A meta-analysis with a random effects model was considered when feasible.

RESULTS

The initial search identified 765 records. After screening for eligibility, we included six cross-sectional and three case report studies. In cross-sectional studies, patients with COPD had almost three times higher odds of having PFO than controls (OR = 2.72, 95 % CI: 1.57 to 4.70, I2 =0 %). When comparing COPD patients with and without PFO, the pooled mean difference was -2.99 mmHg; 95 % CI:5.55 to -0.44, I2 =77 %) in oxygen saturation (SaO2), -6.85 mmHg (95 %CI:11.71 to -2.39, I2 =35 %) in arterial oxygen partial pressure (PaO2) and 9.65 mmHg (95 %CI: 3.38 to 12.92, I2 =0 %) in pulmonary arterial pressure.

CONCLUSIONS

Evidence, based on a few and small size studies, indicates that PFO presence may be associated with worse outcomes in COPD patients. The long-term impact of these findings on COPD outcomes and the need for identifying high-risk patients for PFO screening should be evaluated.