Author + information
An association between large patent foramen ovale (LPFO) and migraine headache has been reported. Vasoactive or inflammatory mediators escaping pulmonary endothelial metabolism by entering systemic circulation through the PFO has been a postulated mechanism. We sought to test this link by measuring arterial and venous levels of a variety of inflammatory or vasoactive mediators in those with LPFO versus small or absent PFO (APFO).
Patients ≤ 55 years of age undergoing clinically indicated left and right heart cardiac catheterization (CC) were enrolled. Subjects underwent saline contrast echo prior to CC. During CC, a blood sample was drawn after catheter discard from the pulmonary artery. Blood draw with discard was similarly performed from the left ventricle upon release of Valsalva. Samples were analyzed for serotonin, leukotriene B4, and a 27–cytokine panel. Pulmonary artery and left ventricular levels of each analyte were measured, and a trans–pulmonary gradient (TPG) computed as arterial–venous concentration for each analyte. Results of subjects with APFO (≤ 5 left heart bubbles at rest or Valsalva) were compared to those with LPFO (≥ 20 left heart bubbles).
A total of 17 patients were enrolled, 8 with APFO, and 9 with LPFO. In those with LPFO, there were significantly increased LV levels of Platelet Derived Growth Factor (p=.025) and Interleukin–12 (p=.032) compared to APFO. However, when we compared the TPG between LPFO and APFO, there were no significant differences. Although Tumor Necrosis Factor levels were out of assay range (OOR) for many subjects, using discrete variables of Detectable and OOR, p= 0.082 by Exact Wilcoxon test for TPG was identified, stratified for LPFO and APFO.
This is the first reported attempt at demonstrating a pathophysiologic link between PFO and migraine headache. Given individual variability in venous and arterial levels of mediators, TPG may be the most appropriate measurement, permitting each patient to serve as their own control. On that basis, no significant differences between LPFO and APFO were found for any mediator. However, the trend in Tissue Necrosis Factor warrants continued study.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Preclinical and Translational Research
Abstract Category: 52. TCT@ACC–i2: Translation and Pre–clinical Research
Presentation Number: 2111–238
- 2013 American College of Cardiology Foundation