Abstract 2446: Effects of Transcatheter Closure of Patent Foramen Ovale on the Systemic Markers of Hemostasis, Inflammation, and Endothelial Function.
Background. No data exists about the systemic effects associated with atrial device implantation for the closure of patent foramen ovale (PFO). The objectives of this study were to evaluate the effects of transcatheter closure of PFO on the serum markers of inflammation, endothelial function, and platelet and coagulation activation.
Methods. We prospectively studied 24 consecutive patients (mean age 43 ± 9 years, 11 males) with previous cryptogenic stroke who underwent successful transcatheter closure of PFO with the Amplatzer PFO occluder. Circulating markers of inflammation (high sensitivity C-reactive protein, hsCRP; Interleukin 6, IL-6), endothelial function (von Willebrand factor, vWF), platelet activation (soluble P-selectin, sP-selectin) and coagulation activation (prothrombin fragment 1+2, F1+2; thrombin-antithrombin III, TAT) were measured the day before the procedure, and at 7, 30, and 90 days following device implantation. All patients were treated with aspirin (325 mg/day). All the same measurements were also performed in a group of 25 healthy controls matched by age and sex.
Results. IL-6 and hsCRP levels increased from 1.8 ± 0.8 pg/mL and 1.7 ± 2.5 mg/L at baseline to a maximal value of 4.8 ± 2.8 pg/mL and 7.4 ± 8.1 mg/L at 7 days after the procedure and progressively returned to the initial values at 90 days (p<0.001 for both markers). A similar pattern was observed for vWF levels which increased from 93±24 IU/dL at baseline to a maximal value of 105±31 IU/dL at 7 days and progressively returned to baseline values at 90 days (p=0.01). There was no significant change in sP-selectin (baseline 39 ± 20 ng/mL) at any time following intervention. The F1+2 and TAT levels increased from 0.40 ± 0.15 nmol/L and 2.0 ± 0.82 ng/mL at baseline to a maximal value of 0.61 ± 0.15 nmol/L and 4.41 ± 1.85 ng/mL at day 7 and returned to baseline values at days 30 and 90 after the procedure (p<0.001 for both markers). The mean levels of IL-6, hsCRP, vWF, F1+2, and TAT at 7 days after PFO closure were significantly higher than those obtained in the control group (p<0.001 for all markers).
Conclusion. Transcatheter closure of PFO is associated with significant systemic inflammation, endothelial dysfunction and coagulation activation within the month following device implantation.