Effect of Patent Foramen Ovale (PFO) Endovascular Closure on Stroke Quality of Life (P4.229)

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. Study Supported by: NIH/NINDS Disclosure: Dr. K has nothing to disclose. Dr. Ning has nothing to disclose. Dr. Deng has nothing to disclose. Dr. Wickham has nothing to disclose. Dr. Inglessis has nothing to disclose. Dr. Lo has nothing to disclose. Dr. Palacios has nothing to disclose. Dr. Buonanno has nothing to disclose.