Migraine in Patients Undergoing PFO Closure

Trabattoni, Daniela; Brambilla, Marta; Canzano, Paola; Becchetti, Alessia; Teruzzi, Giovanni; Porro, Benedetta; Fiorelli, Susanna; Muratori, Manuela; Tedesco, Calogero C.; Veglia, Fabrizio; Montorsi, Piero; Bartorelli, Antonio L.; Tremoli, Elena; Camera, Marina

doi:10.1016/j.jacbts.2022.02.002

Cited by 19 publications

(6 citation statements)

References 32 publications

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“…The study 21 showed a rising trend in the proportion of small lesions and the influenced posterior circulation with an increasing RLS in different cryptogenic stroke patients. Otherwise, PFO was associated with decompression sickness, 4 secondary migraine headache, 5 arterial deoxygenation, and platypnea‐orthodeoxia 6,7 . European position paper 6 suggested proposing PFO closure appropriately.…”

Section: Discussionmentioning

confidence: 99%

“…A PFO is seen in about 25% of the general population and may therefore coexist by chance in a patient with an unexplained left circulation embolism due to right to left shunt (RLS). 1 , 2 PFO is implicated in the pathogenesis of a number of medical conditions such as cryptogenic stroke, 1 , 2 , 3 decompression sickness, 4 secondary migraine headache, 5 arterial deoxygenation, and platypnea‐orthodeoxia. 6 , 7 Early detection of PFO is of major importance for thromboembolic events.…”

Section: Introductionmentioning

confidence: 99%

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The predictive value of abnormal electrocardiogram for patent foramen ovale: A retrospective study

Jin,

Jiao,

Feng

et al. 2023

Clinical Cardiology

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Background and HypothesisThe objective of this study was to identify the characteristics of electrocardiogram (ECG) in adult patients with patent foramen ovale (PFO) and to analyze the predictive value of the characteristics of ECG for PFO in adult patients.MethodsRetrospectively, 267 patients who had undergone ECG, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) with agitated saline contrast echocardiography in our hospital, were recruited continuously from January 2021 to March 2023. Electrocardiographs were analyzed to investigate the presence of right bundle branch block (RBBB) and crochetage R wave.ResultsThe ratio of crochetage R wave in inferior leads in patients with PFO was 45.3% and 21.2% without PFO. There were 17 (6.4%) patients with coexistence of crochetage R wave and RBBB, including 13 (6.5%) patients with PFO and four (6.1%) patients without PFO. The accuracies of TTE, crochetage R wave, and RBBB were 0.637, 0.535, and 0.314, respectively. A combination of crochetage R wave and RBBB demonstrated a sensitivity of 0.507 and a specificity of 0.758. When TTE, crochetage R wave, and RBBB were combined, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 0.712, 0.801, 0.439, 0.813, and 0.420, respectively. Logistic regression analysis revealed a correlation between PFO and the presence of crochetage R wave (odds ratio [OR]: 3.073, 95% confidence interval [CI]: 1.601–5.899, p < 0.001), and also a combination between crochetage R wave and RBBB (OR: 3.220, 95% CI: 1.720–6.028, p < 0.001).ConclusionsCrochetage R wave in ECG was associated with PFO. Crochetage R wave, especially combined with RBBB and TTE, may be helpful in the early detection of patients with PFO.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The predictive value of abnormal electrocardiogram for patent foramen ovale: A retrospective study

Jin,

Jiao,

Feng

et al. 2023

Clinical Cardiology

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“…Increased levels of TF pos -platelets have been reported in several pathological conditions characterized by a prothrombotic phenotype, including thrombocythemia, 5 cancer, 7 antiphospholipid syndrome, 9 viral infections, 8 , 10 and cardiovascular diseases. 6 , 34 The clinical relevance of these findings lays on the significant correlation between platelet-associated TF expression and its functional activity, measured as TG capacity, to residual cardiovascular risk. 10 , 22 Indeed, the translational implications of TF regulation by P2Y 12 receptor are extremely relevant in this setting, considering that treatment with P2Y 12 antagonists is, together with aspirin, the gold standard therapy for secondary prevention of cardiovascular diseases.…”

Section: Discussionmentioning

confidence: 99%

Cell Surface Platelet Tissue Factor Expression: Regulation by P2Y ₁₂ and Link to Residual Platelet Reactivity

Brambilla,

Becchetti,

Rovati

et al. 2023

ATVB

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BACKGROUND: ADP-induced platelet activation leads to cell surface expression of several proteins, including TF (tissue factor). The role of ADP receptors in platelet TF modulation is still unknown. We aimed to assess the (1) involvement of P2Y 1 and P2Y 12 receptors in ADP-induced TF exposure; (2) modulation of TF pos -platelets in anti-P2Y 12 –treated patients with coronary artery disease. Based on the obtained results, we revisited the intracellular localization of TF in platelets. METHODS: The effects of P2Y 1 or P2Y 12 antagonists on ADP-induced TF expression and activity were analyzed in vitro by flow cytometry and thrombin generation assay in blood from healthy subjects, P2Y 12 −/− , and patients with gray platelet syndrome. Ex vivo, P2Y 12 inhibition of TF expression by clopidogrel/prasugrel/ticagrelor, assessed by VASP (vasodilator-stimulated phosphoprotein) platelet reactivity index, was investigated in coronary artery disease (n=238). Inhibition of open canalicular system externalization and electron microscopy (TEM) were used for TF localization. RESULTS: In blood from healthy subjects, stimulated in vitro by ADP, the percentage of TF pos -platelets (17.3±5.5%) was significantly reduced in a concentration-dependent manner by P2Y 12 inhibition only (−81.7±9.5% with 100 nM AR-C69931MX). In coronary artery disease, inhibition of P2Y 12 is paralleled by reduction of ADP-induced platelet TF expression (VASP platelet reactivity index: 17.9±11%, 20.9±11.3%, 40.3±13%; TF pos -platelets: 10.5±4.8%, 9.8±5.9%, 13.6±6.3%, in prasugrel/ticagrelor/clopidogrel-treated patients, respectively). Despite this, 15% of clopidogrel good responders had a level of TF pos -platelets similar to the poor-responder group. Indeed, a stronger P2Y 12 inhibition (130-fold) is required to inhibit TF than VASP. Thus, a VASP platelet reactivity index <20% (as in prasugrel/ticagrelor-treated patients) identifies patients with TF pos -platelets <20% (92% sensitivity). Finally, colchicine impaired in vitro ADP-induced TF expression but not α-granule release, suggesting that TF is open canalicular system stored as confirmed by TEM and platelet analysis of patients with gray platelet syndrome. CONCLUSIONS: Data show that TF expression is regulated by P2Y 12 and not P2Y 1 ; P2Y 12 antagonists downregulate the percentage of TF pos -platelets. In clopidogrel good-responder patients, assessment of TF pos -platelets highlights those with residual platelet reactivity. TF is stored in open canalicular system, and its membrane exposure upon activation is prevented by colchicine.

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“…The platelet-based mechanism hypothesis was reported in a recent article. Trabattoni et al found that PFO had a prothrombotic potential sustained by an altered oxidative stress status in patients with migraine with aura, which could be associated with abnormal 5-HT levels ( 61 ). Furthermore, this association could be reverted after PFO closure by P2Y 12 -blockade.…”

Section: Pathogenesis Of Pfo-related Neurological Diseasesmentioning

confidence: 99%

“…Although studies have reported that clopidogrel resistance is widespread (40% of migraine patients do not respond to treatment), Trabattoni et al found the mechanisms of action of P2Y12 antagonists in the treatment of migraine with aura. Specifically, P2Y 12 antagonists effectively inhibited the oxidative stress-induced platelet-associated tissue factor (TF) and reactive oxygen species (ROS) expression and on microvesicle information ( 61 ). This will bring new hope for the drug treatment of PFO-related migraine with aura.…”

Section: Prevention and Treatment Of Pfo-related Neurological Disordersmentioning

confidence: 99%

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Shi

Sha²,

Li³

et al. 2023

Front. Neurol.

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Patent foramen ovale (PFO) is a common congenital cardiac abnormality when the opening of the interatrial septum is not closed in adulthood. This abnormality affects 25% of the general population. With the development of precision medicine, an increasing number of clinical studies have reported that PFO is closely related to various neurological diseases such as stroke, migraine, obstructive sleep apnea, and decompression syndrome. It has also been suggested that PFO closure could be effective for preventing and treating these neurological diseases. Therefore, increasing attention has been given to the prevention, diagnosis, and treatment of PFO-related neurological diseases. By reviewing existing literature, this article focuses on the pathogenesis, epidemiology, and clinical characteristics of PFO-related neurological diseases, as well as the prevention and treatment of different neurological diseases to discuss, and aims to provide current progress for this field and decision-making evidence for clinical practice.

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Migraine in Patients Undergoing PFO Closure

Cited by 19 publications

References 32 publications

The predictive value of abnormal electrocardiogram for patent foramen ovale: A retrospective study

The predictive value of abnormal electrocardiogram for patent foramen ovale: A retrospective study

Cell Surface Platelet Tissue Factor Expression: Regulation by P2Y ₁₂ and Link to Residual Platelet Reactivity

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

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Migraine in Patients Undergoing PFO Closure

Cited by 19 publications

References 32 publications

The predictive value of abnormal electrocardiogram for patent foramen ovale: A retrospective study

The predictive value of abnormal electrocardiogram for patent foramen ovale: A retrospective study

Cell Surface Platelet Tissue Factor Expression: Regulation by P2Y 12 and Link to Residual Platelet Reactivity

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Contact Info

Product

Resources

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Cell Surface Platelet Tissue Factor Expression: Regulation by P2Y ₁₂ and Link to Residual Platelet Reactivity