Toshihiko Sugiura, Presenter: Nothing to Disclose

Nobusada Funabashi MD, PhD, Abstract Co-Author: Nothing to Disclose

Nobuhiro Tanabe, Abstract Co-Author: Nothing to Disclose

Masae Uehara MD, Abstract Co-Author: Nothing to Disclose

Naoko Kawata MD, Abstract Co-Author: Nothing to Disclose

Yukiko Matsuura, Abstract Co-Author: Nothing to Disclose

Takayuki Zyuzyo MD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Amano MD, Abstract Co-Author: Nothing to Disclose

Seiichiro Sakao MD, Abstract Co-Author: Nothing to Disclose

Yasunori Kasahara, Abstract Co-Author: Nothing to Disclose

Koichiro Tatsumi, Abstract Co-Author: Nothing to Disclose

  To determine the clinical significance of detection of patent foramen ovale (PFO) with flow directional information by multislice CT in subjects with chronic thromboembolic pulmonary hypertension(CTEPH), we compared its incidence with the occurrence of cerebral infarction (CI) detected by MRI.

Retrospective analysis of 33 consecutive subjects (17 F) with proven CTEPH (mean age 56±10 yr), undergoing brain MRI for detecting CI just before performing pulmonary thrombectomy. Presence of PFO with flow directional information was evaluated by enhanced CT. Coronary risk factors, presence of deep venous thrombus (DVT) in the lower extremities, and right heart pressure data were also evaluated.

PFO was detected in 13 subjects (10 right to left, 3 left to right). DVT was found in 19 (58%). CI was present in 5 subjects (all asymptomatic, one cerebellum and 4 lacuna, mean age 57±10 yr, not significant different from those without CI, 56±10 yr, P=0.905). Of the 10 patients with right to left PFO, 20% had CI, not significantly different from those without PFO (15%, P=0.485). Of the total of 13 subjects with any directional PFO, 38% had CI, significantly more than those without PFO (0%, P<0.01). Frequency of DVT, male gender and coronary risk factors, and plasma brain natriuretic peptides, was no different between the groups. Logistic regression models for predicting occurrence of any directional PFO or only right to left PFO were constructed using all clinical variables. The model was simplified in a stepwise fashion and right atrial pressure (RAP) (mmHg) was found to be associated with increased incidence of any directional PFO or right to left PFO (odds ratios 1.237 (95% confidence interval 1.008-1.517), and 1.464 (1.064-2.014), respectively, both P<0.05.

Increased RAP may be associated with increased incidence of any directional PEO and right to left PFO. The incidence of MRI detected CI was significantly higher in subjects with PFO than those without even though ages and coronary risk factors were the same in both groups. Thus, PFO may be associated with increased occurrence of paradoxical CI in patients with CTEPH.Clinical Application identify that the incidence of MRI detected cerebral infarction was significantly higher in subjects with PFO.

PFO may be associated with occurrence of paradoxical CI in patients with CTEPH

Sugiura, T, Funabashi, N, Tanabe, N, Uehara, M, Kawata, N, Matsuura, Y, Zyuzyo, T, Amano, H, Sakao, S, Kasahara, Y, Tatsumi, K, Clinical Significance of Detection of Patent Foramen Ovale with Flow Directional Information by Multislice Computed Tomography in Subjects with Chronic Thromboembolic Pulmonary Hypertension: Influence on Occurrence of Paradoxical Cerebral Infarction.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9010543.html