Identification of Patent Foramen Ovale Channel Related Morphometric Features Increasing the Risk of Cerebrovascular Accidents: a Systematic Review and Meta‐analysis

Abstract

IntroductionIt is still disputable whether specific morphometric features of the patent foramen ovale (PFO) channel may stratify patients by the related probability that a discovered PFO is incidental or stroke related. Thus, we aimed to determine this using a meta‐analytical approach.Materials and MethodsWe performed a systematic review of electronic databases for studies that compared morphometric parameters of PFO channel assessed by transesophageal echocardiography in subjects with cryptogenic cerebrovascular accidents (Group 1) and control (Group 2). Data were extracted and pooled into a meta‐analysis.ResultsA total of 895 patients with PFO channel were reported (Group 1: 493, Group 2: 402). No difference was found in the PFO channel length (Group 1: 10.8 [8.6–12.9] mm vs. Group 2: 10.4 [9.1–11.7] mm), as well as in PFO height measured at rest (Group 1: 2.4 [1.5–3.3] mm vs. Group 2: 1.8 [1.4–2.2] mm). The PFO height measured during Valsalva was larger in Group 1 (3.5 [2.8–4.1] mm) than in Group 2 (1.7 [1.2–2.2] mm). Also, the septal excursion distance was larger in Group 1 (6.4 [5.1–7.8] mm) than in Group 2 (3.1 [1.8–4.4] mm). The risk of cerebrovascular accident was higher in patients with PFO and concomitant septal aneurysm (OR=4.00; 95%CI: 2.63–6.09; p<0.001) and large right‐to‐left shunt PFO (more than 20 microbubbles) (OR=3.81; 95%CI: 2.21–6.55; p<0.001).ConclusionsLarger PFO height during Valsalva, larger septal excursion distance, concomitant atrial septal aneurysm and large right‐to‐left shunt are stroke high‐risk echocardiographic features of the PFO channel.