Int J Cardiovasc Imaging. 2025 Nov 7. doi: 10.1007/s10554-025-03564-x. Online ahead of print.
ABSTRACT
The aim was to evaluate the differential effects of right-to-left shunts (RLS) linked to patent foramen ovale (PFO) on left atrial strain using two-dimensional speckle tracking imaging (2D-STI), and to investigate the prognostic value of left atrial strain in predicting the risk of cryptogenic stroke (CS) related to PFO-RLS. This study involved 81 PFO patients and 45 healthy controls (HCs), who were divided into three groups: the permanent RLS, the latent RLS, and the HC group. Clinical characteristics, conventional echocardiographic parameters, and left atrial strains, such as left atrial reservoir strain (LASr), left atrial conduit strain (LAScd), left atrial contraction strain (LASct), and left atrial stiffness index (LASI) were collected and compared among the three groups. The PFO patients with RLS were subsequently stratified into a CS group and a non-CS group. To identify the predictors of CS in PFO patients with RLS, logistic regression analysis and receiver operating characteristic (ROC) curves were performed. There were no significant differences in left atrial structural parameters among the three groups (all P > 0.05). Compared to the HC group, both the permanent and latent RLS groups demonstrated significantly higher rates of CS (63.4% vs. 35.0% vs. 8.9%, P < 0.001) and migraine (73.2% vs. 60.0% vs. 8.9%, P < 0.001). A graded impairment in left atrial functional parameters was observed across the three groups: LASr (35.40 ± 2.65 vs. 39.18 ± 2.57 vs. 40.19 ± 2.16, P < 0.001), LAScd (-21.55 ± 2.61 vs. -23.99 ± 3.02 vs. -24.86 ± 3.33, P < 0.001), and LASct (-13.86 ± 1.82 vs. -15.19 ± 2.13 vs. -15.33 ± 2.39, P = 0.003). Subgroup analyses revealed reduced LASr (35.29 ± 1.89 vs. 39.20 ± 3.07, P < 0.001) and LAScd (-21.18 ± 2.24 vs. -24.29 ± 2.99, P < 0.001) in the CS group compared to the non-CS group, while LASct showed no statistically significant intergroup difference (P > 0.05). LASr (OR (95%CI): 0.38(0.25-0.57), P < 0.001) and LAScd (OR(95%CI): 1.78(1.33-2.40), P < 0.001) were independent factors for predicting risk of CS related to PFO-RLS. ROC curves analysis demonstrated strong predictive performance of LASr and LAScd for the CS occurrence related to PFO-RLS (LASr: AUC = 0.85, 95%CI = 0.76-0.94, P < 0.001; LAScd: AUC = 0.80, 95%CI = 0.70-0.89, P < 0.001). PFO patients with RLS, especially those with permanent RLS, had impaired left atrial function and an increased risk of CS. The LASr and LAScd were strong predictors and effective indicators of CS in PFO patients with RLS.
PMID:41201706 | DOI:10.1007/s10554-025-03564-x
