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Subclinical MI observed in patients with patent foramen ovale

Wöhrle J. J Am Coll Cardiol Img. 2010;3:833–839.

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More than 10% of patients with patent foramen ovale had detected subclinical MI, according to new study data.

Researchers from Ulm, Germany, analyzed patients (n=74) with patent foramen ovale (PFO) who had a first cryptogenic cerebral ischemic event and did not have a history of MI. The patients underwent CV MRI and coronary angiography, and had right and left ventricular volumes and ejection fractions measured.

Eight (10.8%) of the patients had late gadolinium enhancement (LGE). Researchers determined LGE pattern to be transmural or subendocardial. There was no difference in CV risk factors, type of ischemic event, presence of atrial septal aneurysm, right and left ventricular mass volumes, and ejection fraction in patients with or without LGE. LGE volume was small and consisted of only 7.9 ± 2.4% of LV muscle mass. Overall, patients with LGE vs. those without had a larger PFO size (16.0 ± 2.8 mm vs. 13.2 ± 4.1 mm).

“We were able to demonstrate using CV MRI a 10.8% prevalence of subclinical MIs in patients with PFO after a first cryptogenic cerebral ischemic event,” the researchers commented in their study. “Our results strengthen the pathophysiologic role of a PFO with paradoxical embolism in patients with cryptogenic cerebral ischemic events.”

In accompanying editorial, Y. Chandrashekhar, MD, DM,of the VA Medical Center and University of Minnesota in Minneapolis, explained that this study takes a novel detour compared to previously published literature and adds important information.

“It adds to the growing body of evidence that a PFO has multiple, potentially adverse, consequences that are often not noticed. Although a plethora of literature addresses stroke in patients with a PFO, no systematic study has evaluated embolism in other organ systems,” he wrote. “[This study] also encourages the introduction of better imaging to detect currently unidentified pathology.”

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