Screening and Risk Stratification Strategy Reduced Decompression Sickness Occurrence in Divers With Patent Foramen Ovale

0556960 - ÚI 2023 RIV US eng J - Článek v odborném periodiku
Honěk, J. - Šrámek, M. - Honěk, T. - Šefc, L. - Januška, J. - Fiedler, J. - Horváth, M. - Novotný, Š. - Brabec, Marek - Veselka, J.
Screening and Risk Stratification Strategy Reduced Decompression Sickness Occurrence in Divers With Patent Foramen Ovale.
JACC-Cardiovascular Imaging. Roč. 15, č. 2 (2022), s. 181-189. ISSN 1936-878X. E-ISSN 1876-7591
Institucionální podpora: RVO:67985807
Klíčová slova: decompression sickness * paradoxical embolism * patent foramen ovale * risk stratification * screening
Obor OECD: Statistics and probability
Impakt faktor: 14, rok: 2022
Způsob publikování: Omezený přístup
http://dx.doi.org/10.1016/j.jcmg.2021.06.019

OBJECTIVES: This paper sought to evaluate the occurrence of decompression sickness (DCS) after the application of a patent foramen ovale (PFO) screening and risk stratification strategy. BACKGROUND: PFO is associated with an increased risk of DCS. Recently, transcatheter closure was reported to reduce DCS occurrence in divers with a high-grade shunt. However, to date, there are no data regarding the effectiveness of any PFO screening and risk stratification strategy for divers. METHODS: A total of 829 consecutive divers (age 35.4 ± 10.0 years, 81.5% men) were screened for PFO by means of transcranial color-coded sonography in the DIVE-PFO (Decompression Illness Prevention in Divers with a Patent Foramen Ovale) registry. Divers with a high-grade PFO were offered either catheter-based PFO closure (the closure group) or advised conservative diving (high grades). Divers with a low-grade shunt were advised conservative diving (low grades), whereas those with no PFO continued unrestricted diving (controls). A telephone follow-up was performed. To study the effect of the screening and risk stratification strategy, DCS occurrence before enrollment and during the follow-up was compared. RESULTS: Follow-up was available for 748 (90%) divers. Seven hundred and 2 divers continued diving and were included in the analysis (mean follow-up 6.5 ± 3.5 years). The DCS incidence decreased significantly in all groups, except the controls. During follow-up, there were no DCS events in the closure group, DCS incidence was similar to the controls in the low-grade group (HR: 3.965, 95% CI: 0.558-28.18, P = 0.169) but remained higher in the high-grade group (HR: 26.170, 95% CI: 5.797-118.160, P < 0.0001). CONCLUSIONS: The screening and risk stratification strategy using transcranial color-coded sonography was associated with a decrease in DCS occurrence in divers with PFO. Catheter-based PFO closure was associated with a DCS occurrence similar to the controls, the conservative strategy had a similar effect in the low-grade group, but in the high-grade group the DCS incidence remained higher than in all other groups.
Trvalý link: http://hdl.handle.net/11104/0331077