SPC365

Validation of RoPE and PASCAL scores in a real-world cohort of adult patients undergoing Patent Foramen Ovale Closure: a retrospective study

Session: Posters (Sessão 3 - Écran 7) - Intervenção em cardiopatias congénitas
Speaker: Maria Rita Giestas Lima

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 20. Congenital Heart Disease and Pediatric Cardiology
Subtheme: 20.4 Congenital Heart Disease – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Maria Rita Giestas Lima; Sérgio Maltês; Sérgio Madeira; Inês Carmo Mendes; Duarte Martins; Miguel Mendes; Rui Anjos

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">[Introduction]</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Patent foramen ovale (PFO) is present in about 25% of the general population and in up to 40% of patients with unexplained stroke, suggesting a causal role &ndash; as recently confirmed by positive randomized trials regarding PFO closure. Yet, in real world clinical practice patient selection for PFO closure relies on a probabilistic estimate of causality, based on clinical and PFO anatomical features (Risk of Paradoxical Embolism [RoPE] score and PASCAL classification system [PCS]). Notwithstanding, these tools did not undergo extensive external validation and are not used for stroke recurrence prediction after PFO closure. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">[Aims]</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">The main aims are: 1) to assess the recurrence rate and predictors of systemic circulation thromboembolism (STE) in a population of patients that underwent PFO closure, 2) assess the performance of the RoPE and the PCS for recurrent stroke prediction.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">[Methods]</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">We performed a single-centre retrospective study including consecutive adult patients undergoing PFO closure between 2007-2017. Patient&rsquo;s baseline demographics and arterial thromboembolism recurrence were assessed. Univariate and multivariate regression analysis were performed to identify recurrent STE after intervention.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">[Results]</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">A total of 259 patients (57% female, mean age 50&plusmn;13 years old, 35% hypertensive, 42% with dyslipidaemia, 9% diabetic, 27% smokers, 0.4% and 4% with atrial fibrillation pre and post closure, respectively, with a mean CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 1.09&plusmn;1.045, 5% with stable significant carotid stenosis &ge; 50%) were included (figure 1A). Most patients had atrial septum aneurism (44%) and 19% had a large shunt (&gt;20 bubbles). The main indications for PFO closure were prior ischaemic stroke (98%) or other systemic emboly (2%). 51% patients had imaging evidence of cortical stroke. The mean RoPE score was 5.4&plusmn;1.8 (32% with a RoPE score &ge;7) and 54% of patients had a medium to high PCS. During a mean follow up of 10&plusmn;2 years, the cumulative STE recurrence rate was 6% or 7 events per 1000 patient-years. When performing multivariate analysis, diabetes (OR 0.218 95% CI 0.061-0.778; p=0.048), carotid stenosis (OR 7.803 95% CI 1.974-30.855]; p=0.003)&nbsp; predicted STE recurrence (figure 1B). Neither RoPE (p=0.101) nor PCS (p=0.618) predicted recurrent STE.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">[Conclusion]</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">In a large single-centre cohort of adult patients undergoing PFO closure, recurrent STE rates were within range of previous series and mostly predicted by systemic comorbidities.</span></span></span></p>