The relationship between anxiety and patent foramen ovale: a preliminary study

BACKGROUND: Anxiety disorders are prevalent mental health conditions with complex pathogenesis and limited treatment efficacy. While links between patent foramen ovale (PFO) and migraine, and between migraine and anxiety are established, no study has explored PFO-anxiety association in non-migraine populations. We conducted a retrospective observational study to examine PFO-anxiety correlation in anxiety disorder patients and propose potential mechanistic pathways. METHODS: A total of 103 consecutive patients with ICD-10-confirmed anxiety disorders were recruited from Hebei General Hospital. Anxiety severity was stratified into mild-to-moderate and severe groups using the Hamilton Anxiety Rating Scale (HAMA). The grade of right-to-left shunt (RLS) through patent foramen ovale (PFO) was quantified via agitated saline contrast echocardiography (ASCE). Correlation analysis and multiple linear regression were applied to identify factors associated with anxiety severity. RESULTS: Fifty-four patients had mild to moderate anxiety, and forty-nine patients had severe anxiety. Eighty (77.67%) patients with anxiety were positive for patent foramen ovale. Furthermore, the anxiety level of inpatients was greater than that of outpatients and the anxiety level of patients with a positive right-to-left shunt via patent foramen ovale was greater than that of patients with a negative shunt. Spearman correlation analysis revealed a strong positive association between RLS grade and anxiety severity (r = 0.817, p < 0.001). CONCLUSION: This preliminary observational study identifies a statistically significant association between anxiety severity, PFO presence and RLS grade in patients with anxiety disorders. A key limitation of this work is its retrospective design, which precludes confirmation of causal relationships between the observed variables. Potential underlying mechanisms including neurohumoral dysregulation, cerebrovascular compromise, and autonomic nervous system dysfunction are proposed for future investigation. These findings provide a novel perspective for anxiety pathophysiology research, and further validation in large, well-controlled cohort studies is warranted.