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PFO-spectrum disorder: two different cerebrovascular diseases in patients with PFO as detected by AI brain imaging
Raluca Ștefania Badea1,2, Sorina Mihăilă-Bâldea2,3, Athena Ribigan1,2
1Department of Neurology, University and Emergency Hospital, Bucharest, Romania.
Insights
Patent foramen ovale (PFO) may link to distinct cerebrovascular issues. Patients without stroke history showed higher white matter lesions, suggesting PFO
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Patent foramen ovale (PFO) is a common remnant of fetal circulation.
- PFO can be a risk factor for stroke or asymptomatic white matter (WM) lesions.
- The relationship between PFO characteristics and cerebrovascular events is not fully understood.
Purpose of the Study:
- To compare the burden and distribution of cerebral WM lesions in PFO patients with and without stroke history.
- To investigate the association between PFO morphology, shunt severity, and ischemic events.
- To explore the impact of PFO on the volume of cerebral WM lesions.
Main Methods:
- Retrospective case-control study of 67 PFO patients.
- Transesophageal echocardiography for PFO confirmation.
- Transcranial Doppler for shunt assessment and MRI for WM lesion quantification.
Main Results:
- No significant difference in overall WM lesion burden between groups.
- WM lesion volume, excluding stroke, was higher in patients without stroke history (0.27 cm³ vs 0.08 cm³).
- Patients with stroke history tended to have larger PFOs and greater shunt volumes.
Conclusions:
- PFO may be associated with two distinct cerebrovascular conditions: stroke and "silent" WM lesions.
- These conditions may present with different imaging patterns.
- Further research is needed to identify high-risk PFOs and understand their clinical implications.
Background:
Patent foramen ovale (PFO) is a prevalent cardiac remnant of fetal anatomy that may pose a risk factor for stroke in some patients, while others can present with asymptomatic white matter (WM) lesions. The current study aimed to test the hypothesis that patients with a PFO who have a history of stroke or transient ischemic attack, compared to those without such a history, have a different burden and distribution of cerebral WM hyperintensities. Additionally, we tested the association between PFO morphological characteristics and severity of shunt, and their impact on the occurrence of ischemic cerebral vascular events and on the burden of cerebral WM lesions.
Patients And Methods:
Retrospective, case-control study that included patients with PFO confirmed by transesophageal echocardiography. Right-to-left shunt size was assessed using transcranial Doppler ultrasound. Cerebral MRIs were analyzed for all participants using the semi-automated Quantib NDTM software for the objective quantification of WM lesions. WM lesions volume was compared between patients with and without a history of stroke. Additionally, the anatomical characteristics of PFOs were assessed to explore their relation to stroke occurrence and WM lesions volume.
Results:
Of the initial 264 patients diagnosed with PFO, 67 met the inclusion criteria and were included in the analysis. Of them, 62% had a history of PFO-related stroke/TIA. Overall burden of WM lesions, including stroke volume, was not significantly different (p = 0.103). However, after excluding stroke volume, WM lesions volume was significantly higher in patients without stroke (0.27 cm3, IQR 0.03-0.60) compared to those with stroke/TIA (0.08 cm3, IQR 0.02-0.18), p = 0.019. Patients with a history of PFO-related stroke/TIA had a tendency to larger PFO sizes by comparison to those without, in terms of length and height, and exhibited greater right-to-left shunt volumes.
Discussion:
We suggest that PFO may be associated with the development of two distinct cerebrovascular conditions (stroke and "silent" WM lesions), each characterized by unique imaging patterns. Further studies are needed to identify better the "at-risk" PFOs and gain deeper insights into their clinical implications.
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