No abstract

No abstract

Introduction. In subjects aged <55 years, the association between patent foramen ovale (PFO) and cryptogenetic cerebrovascular (CV) events is well established. In the clinical management of the PFO, a thrombophilic screening including homocysteinaemia (Hcy) determination and methylenetetrahydrofolate reductase polymorphism (MTHFR) evaluation for the C677T gene are recommended. Methods. One hundred and three hypertensive subjects (blood pressure >140/90mmHg or under antihypertensive treatment), of which 63 men and 40 women (aged 49.8± 11.3 years) with hyper-Hcy (i.e. >14μg/dL) referring to our Hypertension Centre, undergo a trans-thoracic echocardiogram (Eco-T) and evaluation of MTHFR polymorphism (CC, CT, TT) for the C677T gene mutation. Continuous variables were expressed as mean ± standard deviation; analysis of variance was used to comparing groups, and Pearson chi square ^2 test to compare the prevalence of categorical variables. Results. Eighteen mutated cases were found (10 TT and 8 CT). Eco-T discovered 10 cases (7 men and 3 women) of unknown PFO with a left-right shunt (subsequently confirmed by trans-oesophageal echocardiography). PFO prevalence was significantly higher in TT than CT and CC subjects (see figure); in subjects with PFO, Hcy was significantly increased in TT than in CC subjects (see figure 1); no difference both systolic and diastolic blood pressure was found in TT than in CC (166. 4±1.4 vs 159.8± 14.6 mmHg and 94.4±4.2 vs 92.8± 3.0 mmHg, respectively).Conclusions. Although PFO prevalence at population level was around of 25%, in the hypertensive subject it would seem to associate with hyper-Hcy and homozygosis for MTHFR 677. Currently no randomized clinical studies are available for the PFO management in subjects having hyper-Hcy and homozygosis for MTHFR. In this subjects hypertension increase per se the global CV risk, putting a question if the endo-vascular treatment of PFO must be performed independently from its entity.