Assessment of Left Atrial Mechanics in Patients With Cryptogenic Stroke and Patent Foramen Ovale

Objectives To identify clinical, radiological and echocardiographic features associated with indication to percutaneous patent foramen ovale (PFO) closure, with a specific focus on left–atrial functional indices, in a real–world cohort of patients with cryptogenic cerebrovascular ischemic event and PFO. Methods In this single–centre retrospective study of 225 patients discussed for percutaneous PFO closure by a multidisciplinary team between 2011 and 2023, clinical, radiological and echocardiographic features of both groups with and without indication for PFO closure were compared. Results PFO closure was recommended in 54.7% of patients. Independent predictors of indication were relevant interatrial shunt (OR 20.717; p‹0.001) and PASCAL classification as “probable” (vs “possible”, OR 6.457; p=0.001). Cortical location of ischemic lesion showed borderline evidence (OR 2.864; p=0.051). The Left Atrioventricular Coupling Index (LACI) was inversely associated with referral (OR 0.933 per 1% increase; p=0.017), whereas conventional left–atrial indices (left atrial maximum and minimum volumes, left atrial emptying fraction, atrial strain and atrial electromechanical delay) did not show association. Conclusions In this cohort of patients with criptogenic stroke and patent foramen ovale, selection for percutaneous closure, based on a multifactorial and interdisciplinary assessment, was primarily driven by shunt severity, PFO–stroke causal likelihood (PASCAL) and radiological embolic features. The Left Atrial Coupling Index (LACI) provided complementary functional information as a global indicator of individual cardiovascular and thromboembolic profile, potentially useful for refining patient selection.