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Updated: Aug 17, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Change in patent foramen ovale height is associated with cryptogenic stroke and the construction of a
Xiaoqin Liu1, Yu Zhang1, Hang Xie1
1Department of Structural Heart Disease, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Insights
A new scoring system helps identify stroke risk from patent foramen ovale (PFO) morphology. This tool aids in selecting patients with PFO-related cryptogenic stroke (CS) who may benefit from PFO closure.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Patent foramen ovale (PFO) is implicated in cryptogenic stroke (CS), but identifying causative PFOs is difficult.
- Current guidelines recommend PFO occlusion for PFO-related CS, necessitating better patient selection.
- PFO morphology and associated factors are crucial for understanding stroke risk.
Purpose of the Study:
- To identify predictors of PFO-related cryptogenic stroke (CS).
- To develop and validate a scoring system for assessing PFO-related CS risk.
- To guide clinical decisions regarding PFO occlusion.
Main Methods:
- Prospective, multicenter clinical trial data including transesophageal echocardiography (TEE) and clinical history.
- Logistic regression analysis to identify independent predictors of CS.
- Development and validation of a scoring system using ROC analysis.
Main Results:
- Change in PFO height, large PFO, atrial septal aneurysm (ASA), and sustained right-to-left shunt (RLS) were independent predictors of CS.
- A scoring system was developed: PFO height change ≥ 1.85 mm (3 pts), large PFO (2 pts), ASA (5 pts), sustained RLS (2 pts).
- The scoring system demonstrated an AUC of 0.80 for predicting CS, with increasing CS risk correlating with higher scores.
Conclusions:
- Change in PFO height is a significant independent predictor of CS.
- A simple scoring system can effectively guide the identification of causal PFOs.
- This scoring system aids in selecting patients likely to benefit from PFO closure.
Introduction:
Current guidelines recommended patent foramen ovale (PFO) occlusion as the preferred treatment for PFO-related cryptogenic stroke (CS); however, finding the causative foramen ovale remains challenging. This study aimed to identify predictors and establish a scoring system by assessing PFO morphology and stroke-related factors.
Methods:
Based on a prospective multicenter registered clinical trial, we compared data mainly derived from transesophageal echocardiography (TEE) and clinical history in patients with PFO-related CS and those without CS (non-CS) with incidental PFO. Subsequently, we explored independent predictors using logistic analysis, established a scoring system based on the results, and finally evaluated the scoring system using receiver operating characteristic (ROC) analysis and internal validation.
Results:
75 patients with PFO-related CS and 147 non-CS patients were enrolled. Multivariate logistic analysis showed that the change in PFO height, large PFO, atrial septal aneurysm (ASA), and sustained right-to-left shunt (RLS) had independent relationships with CS. Based on the odds ratio value of each independent factor, a scoring system was built: change in PFO height ≥ 1.85 mm (3 points), large PFO (2 points), ASA (5 points), sustained RLS (2 points). 0-2 points correspond to low-risk PFO, 3-5 points medium-risk PFO, and 7-12 points high-risk PFO. ROC analysis showed an area under the curve of 0.80 to predict CS. The proportion of patients with CS is increasing based on these points.
Conclusions:
Our study screened out the change in PFO height as an independent predictor of CS. A simple and convenient scoring system can provide constructive guidance for identifying whether the PFO is causal and consequently selecting patients more likely to benefit from closure.
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