Quantitative Parameters of Transesophageal Echocardiography in Predicting the Risk of Cardiovascular and Cerebrovascular Events in Patients with Unclosed Foramen Ovale and Atrial Fibrillation

DU Lijun; WANG Junwei; WANG Xu

doi:10.12102/j.issn.1672-1349.2025.13.015

Abstract：Objective: To explore the predictive value of transesophageal echocardiographic quantitative parameters for the risk of cerebrovascular and cardiovascular events in patients with patent foramen ovale (PFO) combined with atrial fibrillation. Methods: A total of 165 patients with PFO combined with atrial fibrillation admitted to our hospital from January 2021 to May 2022 were selected as the study subjects. According to the severity of atrial fibrillation symptoms, the patients were divided into three groups: paroxysmal atrial fibrillation group (62 cases), persistent atrial fibrillation group (54 cases), and permanent atrial fibrillation group (49 cases). The transesophageal echocardiographic quantitative parameters [left atrial diameter (LAD), left ventricular ejection fraction (LVEF), left atrial appendage (LAA) ejection fraction (LAAEF), LAA blood flow emptying velocity (LFEV), LAA blood flow filling velocity (LFFV), LAA minimum area (LAAmin), LAA maximum area (LAAmax)] were compared among the three groups. Spearman correlation coefficient was used to analyze the correlation between transesophageal echocardiographic quantitative parameters and the severity of atrial fibrillation symptoms. The occurrence of cerebrovascular and cardiovascular events within one year after treatment was recorded, and clinical data before treatment were compared between patients who did and did not experience such events. Logistic regression analysis was used to identify factors influencing the occurrence of cerebrovascular and cardiovascular events. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of transesophageal echocardiographic quantitative parameters for cerebrovascular and cardiovascular events in patients with PFO combined with atrial fibrillation. Results: There were no statistically significant differences in LAD and LVEF among the three groups (P > 0.05). The LAAEF, LFEV, and LFFV were lower in the permanent atrial fibrillation group compared to the persistent and paroxysmal atrial fibrillation groups (P < 0.05). The LAAEF, LFEV, and LFFV were also lower in the persistent atrial fibrillation group compared to the paroxysmal atrial fibrillation group (P < 0.05). The LAAmin and LAAmax were higher in the permanent atrial fibrillation group compared to the persistent and paroxysmal atrial fibrillation groups (P < 0.05), and higher in the persistent atrial fibrillation group compared to the paroxysmal atrial fibrillation group (P < 0.05). Before treatment, LAD, LVEF, LAAEF, LFEV, LFFV, LAAmin, and LAAmax were all independent risk factors for cerebrovascular and cardiovascular events after treatment (P < 0.05). The areas under the curve (AUC) for predicting cerebrovascular and cardiovascular events using these parameters were 0.741, 0.749, 0.768, 0.814, 0.714, 0.804, and 0.742, respectively. The combined prediction had the highest AUC of 0.931 (P < 0.05). Conclusion: Transesophageal echocardiographic quantitative parameters have certain predictive value for the risk of cerebrovascular and cardiovascular events in patients with PFO combined with atrial fibrillation.