Effect of Residual Interatrial Shunt on Migraine Burden After Transcatheter Closure of Patent Foramen Ovale
| Autor: | Dhaval Kolte, Eugene Pomerantsev, Ferdinando S. Buonanno, Rahul Sakhuja, MingMing Ning, Sammy Elmariah, Pablo Rengifo-Moreno, Judy Hung, Igor F. Palacios, Ricardo J. Cigarroa, Lucia M. Vaina, Rasha Al-Bawardy, Ignacio Cruz-González, Ignacio Inglessis, Eyal Ben-Assa |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Cardiac Catheterization medicine.medical_specialty Time Factors Septal Occluder Device Aura Migraine Disorders Right-to-left shunt Foramen Ovale Patent 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Risk Factors law Interquartile range Coronary Circulation Internal medicine medicine.artery medicine Humans 030212 general & internal medicine Retrospective Studies business.industry Odds ratio Middle Aged medicine.disease Confidence interval Treatment Outcome Migraine Cardiology Patent foramen ovale Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC: Cardiovascular Interventions. 13:293-302 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2019.09.042 |
| Popis: | Objectives This study sought to evaluate the long-term effect of transcatheter patent foramen ovale (PFO) closure on migraineurs with and without aura and examine the effect of residual right-to-left shunt. Background Many studies reported improvement in migraine symptoms after PFO closure, yet randomized trials failed to reach its clinical endpoints. Methods The study retrospectively analyzed data from 474 patients who underwent transcatheter PFO closure at Massachusetts General Hospital. Patients completed a migraine burden questionnaire at baseline and at follow-up. Migraine severity is reported as migraine frequency (days/month), average duration (min), and migraine burden (days × min/month). Improvement following closure was defined as complete abolishment of symptoms or >50% reduction in migraine burden. Results A total of 110 migraineurs who underwent PFO closure were included; 77.0% had aura and 23.0% were without aura, and 91.0% had a cryptogenic stroke. During long-term median follow-up of 3.2 (interquartile range: 2.1 to 4.9) years, there was a significant improvement in migraine symptoms in migraineurs with or without aura. Migraine burden was reduced by >50% in 87.0% of patients, and symptoms were completely abolished in 48%. Presence of aura was associated with abolishment of migraine (odds ratio: 4.30; 95% confidence interval: 1.50 to 12.30; p = 0.006). At 6 months after PFO closure, residual right-to-left shunt was present in 26% of patients. Absence of right-to-left shunt was associated with improvement in migraine burden by >50% (odds ratio: 4.60; 95% confidence interval: 1.30 to 16.10; p = 0.017). Conclusions Long-term follow-up after transcatheter PFO closure was associated with significant improvement in migraine burden. Aura was a predictor of abolishing symptoms. Absence of residual right-to-left shunt was a predictor of significant reduction in migraine burden. |
| Databáze: | OpenAIRE |
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