Effect of patent foramen ovale (PFO) endovascular closure on stroke quality of life

Objective/Background: Patent foramen ovale (PFO) is an independent stroke risk factor associated with more than 150,000 strokes per year in the US. PFO stroke patients tend to be younger - of child bearing age, enjoy an active lifestyle and are a major component of the work force, who are not long-term anticoagulant candidates. While clinical trials have demonstrated variable results in PFO closure vs medical treatment, younger stroke patients tend to prefer endovascular closure rather than long-term anticoagulation. We found previously that PFO related stroke is a multi-organ disease affecting the brain, heart, and circulation, and have implemented multi-disciplinary care from neurology, cardiology and hematolgy. Here we investigate the effect of PFO closure for stroke prevention on patients' quality of life.Design/Methods: Patients were recruited per IRB-approved protocol from the MGH Cardio-Neurology Clinic. To quantify the effect of PFO closure on depression and anxiety, validated Becks Depression and Anxiety Inventory were performed at 3 months before and 3-6 months after PFO closure. Clinical data on stroke severity, outcome and blood samples were also collected and analysed.Results: Consecutive PFO stroke patients (age range 20-55; 54% male) adjudicated by vascular neurologists were enrolled. No new treatments (e.g. anti-depressant/anti-anxiety meds) were initiated during the study. After successful PFO closure, patients had significantly improved anxiety (post vs pre - 5.8 vs 3, p<0.05) and depression scores (post vs pre 3 vs 2.5, p<0.05). Cortisol level also lowered significantly post PFO closure.Conclusion: PFO stroke patients have improved quality of life after PFO closure as measured by validated quantitative anxiety and depression scales under multi-disciplinary care. Patient's stress hormone levels were also lowered post PFO closure. These findings demonstrate the importance of a multi-disciplinary approach to stroke patient care, and individualizing care in younger stroke patients. Longer term future studies are needed to understand the effect of PFO closure vs multi-disciplinary specialized care.