Kardiologia polska · 2026
Evaluation of the severity of right-to-left shunt in patent foramen ovale patients after systemic embolism (MEASURE-PFO study).
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Stasek Josef, Bis Josef, Dusek Jaroslav, Medilek Karel, Dostal Jiri, Branny Marian, Mrozek Jan, Porzer Martin, Mates Martin, Kopriva Karel, Zelizko Michael, Karmazin Vladimir, Poloczek Martin, Kala Petr, Kovarnik Tomas, Zemanek David, Linhart Ales, Benesova Klara, Jarkovsky Jiri, Parizek Petr, Measure-Pfo Investigators On Behalf Of The
Аннотация
BACKGROUND: Patent foramen ovale (PFO) is the most common inherited cardiac abnormality, with intermittent right-to-left (R-L) shunt of variable size.
AIMS: To study the quantification of R-L shunt (shunt) in PFO patients using an original thermodilution method in relationship to the morphology of the interatrial septum, measured by echocardiography and cardiopulmonary exercise tests before and after the occlusion of a PFO.
METHODS: A multicenter study enrolled a population of 151 patients, eligible for PFO closure in secondary prevention, who underwent transthoracic echocardiography, contrast transesophageal echocardiography, and cardiopulmonary exercise tests before and 6 months after the closure. The size of the shunt was measured by catheterization using the thermodilution Inntherm® system.
RESULTS: Shunt was detected in 133 (90%) patients. Size of shunt >20% was present in 41 (28%) patients, 10%-20% in 33 (22%), and <10% in 49 (40%) patients. Shunt size >10% was associated with greater atrial septal separation during the Valsalva (P = 0.03) and respiration (P = 0.04), amplitude of septal displacement (P = 0.009), amount of contrast media in the left atrium (P = 0.03), and hypermobility of septum (P = 0.03). After PFO closure, work (W) capacity increased in patients with shunt ≥20% (Δ +6.8; standard deviation [SD] 16.9 [W]) compared with those with <10% (Δ -2.1; SD 24.5 [W]; P = 0.02). Migraine occurrence decreased in 8 patients (62%) (P = 0.008). A decrease in saturation on exercise occurred in 12 cases (9%), after the PFO closure saturation normalized from 90.5% to 95.0% (P = 0.009), with no effect on exercise.
CONCLUSIONS: We proved safe use of thermodilution for R-L shunt measurement. The main cause of inducible shunt severity is atrial septal mobility. A severe PFO shunt impacts work capacity.
AIMS: To study the quantification of R-L shunt (shunt) in PFO patients using an original thermodilution method in relationship to the morphology of the interatrial septum, measured by echocardiography and cardiopulmonary exercise tests before and after the occlusion of a PFO.
METHODS: A multicenter study enrolled a population of 151 patients, eligible for PFO closure in secondary prevention, who underwent transthoracic echocardiography, contrast transesophageal echocardiography, and cardiopulmonary exercise tests before and 6 months after the closure. The size of the shunt was measured by catheterization using the thermodilution Inntherm® system.
RESULTS: Shunt was detected in 133 (90%) patients. Size of shunt >20% was present in 41 (28%) patients, 10%-20% in 33 (22%), and <10% in 49 (40%) patients. Shunt size >10% was associated with greater atrial septal separation during the Valsalva (P = 0.03) and respiration (P = 0.04), amplitude of septal displacement (P = 0.009), amount of contrast media in the left atrium (P = 0.03), and hypermobility of septum (P = 0.03). After PFO closure, work (W) capacity increased in patients with shunt ≥20% (Δ +6.8; standard deviation [SD] 16.9 [W]) compared with those with <10% (Δ -2.1; SD 24.5 [W]; P = 0.02). Migraine occurrence decreased in 8 patients (62%) (P = 0.008). A decrease in saturation on exercise occurred in 12 cases (9%), after the PFO closure saturation normalized from 90.5% to 95.0% (P = 0.009), with no effect on exercise.
CONCLUSIONS: We proved safe use of thermodilution for R-L shunt measurement. The main cause of inducible shunt severity is atrial septal mobility. A severe PFO shunt impacts work capacity.