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Increased Blood Residence Time as Markers of High-Risk Patent Foramen Ovale

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Abstract

Previous investigations have suggested that patients with patent foramen ovale (PFO) often have an atrial dysfunction, like to that observed in patients with atrial fibrillation (AF) which may concur to an increased risk of cryptogenic stroke. The aim of the study is to compare the atrial resident time (Rt) of PFO patients to those with sinus rhythm (SR) and AF using patient-specific 3D computational fluid dynamics (CFD) analysis. Models of left atrium (LA) hemodynamics were obtained from time-resolved CT scans and transthoracic echocardiography (TTE). Enrolled patients were divided into three groups: 30 healthy subjects with SR, 30 with PFO, and 30 with AF without PFO. Blood stasis was evaluated by determining the blood residence time (Rt) distribution in the LA and left atrial appendage (LAA). Overall, 90 patients (mean age 47.4 ± 7.5 years, 51 males) were included into the analysis. PFO patients exhibit higher mean Rt values compared to healthy subjects (2.65 ± 0.2 vs 1.5 ± 0.2 s). Conversely, AF patients presented higher Rt when compared to PFO patients (2.9 ± 0.3 vs 2.3 ± 0.2 s). Moreover, PFO patients presenting cerebral lesions at magnetic resonance imaging have a higher Rt compared to those without (2.9 ± 0.3 vs 2.3 ± 0.2 s, respectively, p < 0.001). PFO patients have a higher degree of atrial Rt compared to healthy subjects similar to that observed in AF patients. The higher mean LA Rt values offer an insight into the pathophysiological mechanism linking PFO with cryptogenic stroke and might be a marker of high-risk PFOs.

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Author notes

  1. Gianluca Rigatelli and Marco Zuin contributed equally to this work.

Authors and Affiliations

  1. Adult Congenital Heart Disease, Rovigo General Hospital, Rovigo, Italy

    Gianluca Rigatelli

  2. Department of Translational Medicine, University of Ferrara, Ferrara, Italy

    Marco Zuin

  3. Division of Cardiology, Rovigo General Hospital, Rovigo, Italy

    Loris Roncon

Authors
  1. Gianluca Rigatelli
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  2. Marco Zuin
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  3. Loris Roncon
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Contributions

Gianluca Rigatelli and Marco Zuin: conceptualization, draft the manuscript, performed the analysis. Loris Roncon: collected the data and supervised the manuscript. All authors read the final version and approved the manuscript.

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Correspondence to Gianluca Rigatelli.

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Rigatelli, G., Zuin, M. & Roncon, L. Increased Blood Residence Time as Markers of High-Risk Patent Foramen Ovale. Transl. Stroke Res. 14, 304–310 (2023). https://doi.org/10.1007/s12975-022-01045-0

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