The Risk of Heart Failure Progression in Patients With Patent Foramen Ovale: Differential Risk Associated With Device Closure
Related Experiment Video
Updated: Aug 2, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Jiesuck Park1, Soo Yeon An2, Hong-Mi Choi1
1Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Jongro-gu, Seoul, Republic of Korea.
Insights
Device closure of patent foramen ovale (PFO) may increase heart failure (HF) risk in patients with structural heart disease or atrial fibrillation (AF). Careful monitoring is advised for these individuals post-procedure.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Patent foramen ovale (PFO) can reduce left atrial pressure through an interatrial shunt.
- Investigating the link between PFO device closure and subsequent heart failure (HF) risk is crucial, especially in vulnerable patient groups.
Purpose of the Study:
- To determine if device closure of PFO is associated with an increased risk of heart failure (HF).
- To assess this risk specifically in patients with pre-existing structural heart disease or atrial fibrillation (AF).
Main Methods:
- A cohort of 4,804 patients undergoing transesophageal echocardiography was analyzed.
- The study followed patients for a median of 3.5 years, assessing the 4-year risk of HF hospitalization as the primary outcome.
- Underlying structural heart disease was identified via echocardiography.
Main Results:
- PFO was present in 20.4% of patients; 161 underwent device closure.
- PFO closure was associated with a significantly higher risk of HF hospitalization (5.5% vs. 1.2%) compared to no closure in PFO patients.
- This increased HF risk post-PFO closure was particularly pronounced in patients with structural heart disease or AF (aHR, 2.55), but not significant in those without these conditions.
Conclusions:
- PFO device closure may predispose patients with structural heart disease or AF to symptomatic HF progression.
- Close medical surveillance and optimized risk management are essential for these patients following PFO closure.
Background:
A patent foramen ovale (PFO) can unload left atrial pressure via an interatrial shunt. We investigated whether device closure of PFO is associated with a subsequent risk of heart failure (HF), particularly in patients with structural heart disease or atrial fibrillation (AF).
Methods:
We enrolled 4,804 consecutive patients who underwent transesophageal echocardiography at tertiary medical centers in Korea between 2007 and 2019. The primary outcome was the 4-year risk of HF hospitalization. Underlying structural heart disease was determined by echocardiography.
Results:
A PFO was observed in 981 (20.4%) patients, where 161 underwent device closure. During follow-up (median, 3.5 [1.4-6.4] years), the primary outcome was lower in patients with PFO than in those without (2.6% vs 4.0%; adjusted hazard ratio [aHR], 0.65; 95% CI, 0.45-0.94; P = .021). Among the patients with PFO, the primary outcome was higher in the device closure group than in the no-closure group (5.5% vs 1.2%; aHR, 5.59; 95% CI, 4.26-7.34; P < .001). A consistent result was found in patients with structural heart disease or AF (9.6% vs 3.9%; aHR, 2.55; 95% CI, 1.95-3.33; P < .001), demonstrating an increased risk of the primary outcome proportionate to the number of combined structural abnormalities. However, no significant association was observed between the primary outcome and PFO closure in those without structural heart disease or AF (1.7% vs 1.5%; aHR, 1.22; 95% CI, 0.99-1.50; P = .054).
Conclusion:
Patients with underlying structural heart disease or AF may be predisposed to symptomatic HF progression after PFO closure. Therefore, careful medical surveillance with optimal risk management is needed in these patients.
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