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Association between patent foramen ovale and chronic obstructive pulmonary disease: A systematic review and
Sruthy Balakumar1, Naya Nadeem2, Areeba Asghar3
1University of Toronto, Faculty of Arts and Science, Public Health and Human Biology, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
Insights
Patent foramen ovale (PFO), a heart defect, is more common in patients with chronic obstructive pulmonary disease (COPD). PFO may be linked to worse COPD outcomes, warranting further investigation and potential screening.
Area of Science:
- Cardiology
- Pulmonology
- Medical Diagnostics
Background:
- Patent foramen ovale (PFO) is a postnatal closure defect of the intra-atrial septum.
- Chronic obstructive pulmonary disease (COPD) is characterized by airflow obstruction.
Purpose of the Study:
- To systematically review and consolidate evidence on the association between PFO and COPD outcomes.
- To evaluate the impact of PFO on individuals diagnosed with COPD.
Main Methods:
- Systematic literature search of Medline, Embase, and Cochrane databases up to November 2023.
- Inclusion of studies on adult COPD patients tested for PFO.
- Data extraction and consideration of meta-analysis for quantitative synthesis.
Main Results:
- Six cross-sectional and three case reports were included.
- COPD patients demonstrated nearly three times higher odds of PFO compared to controls (OR = 2.72).
- PFO presence in COPD patients was associated with reduced oxygen saturation (SaO2) and arterial oxygen partial pressure (PaO2), and elevated pulmonary arterial pressure.
Conclusions:
- Preliminary evidence suggests a potential association between PFO and adverse outcomes in COPD patients.
- Further research is needed to elucidate the long-term impact and identify high-risk individuals for PFO screening.
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.
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