{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:55:21Z","timestamp":1790751321162,"version":"4.1.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To prospectively investigate the association between patent foramen ovale (PFO), detected via agitated saline contrast echocardiography (ASCE), and anxiety using a deep learning approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This prospective study consecutively enrolled 161 participants between July 15, 2025 and October 31, 2025. Participants were stratified into ASCE-negative (n=58) and ASCE-positive (n=103) groups based on the examination results. All participants underwent ASCE and anxiety assessment using the Self-Rating Anxiety Scale (SAS). An artificial intelligence model was developed using a 10-fold cross-validation approach on the 103 ASCE-positive videos to predict anxiety scores. The primary endpoint was the association between PFO and anxiety, while the deep learning model was evaluated as a secondary\/exploratory endpoint. Statistical analyses, including logistic regression, were performed with statistical significance set at p&amp;lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to the ASCE-negative group, the ASCE-positive group exhibited significantly higher anxiety levels (SAS score: 45.0 vs. 38.0, p&amp;lt;0.001) and a higher prevalence of anxiety (32.0% vs. 5.2%, p&amp;lt;0.001). Logistic regression identified a strong association between ASCE-positive status and anxiety (adjusted odds ratio=8.64, p&amp;lt;0.001), with no clear dose-dependent relationship across shunt grades. The imaging-only deep learning model achieved a mean absolute error (MAE) of 5.76 \u00b1 0.12 and an R\u00b2 of 0.46 \u00b1 0.03 across cross-validation folds. After incorporating clinical and sociodemographic confounders, the model\u2019s performance improved to an MAE of 5.15 \u00b1 0.10 and an R\u00b2 of 0.59 \u00b1 0.02.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This prospective study confirms a significant association between PFO and anxiety and demonstrates the feasibility of using ASCE-based deep learning models to predict anxiety risk, although clinical application requires external validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1877855","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:00:05Z","timestamp":1790748005000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between patent foramen ovale and anxiety: a prospective study with deep learning-assisted analysis of contrast echocardiography"],"prefix":"10.3389","volume":"17","author":[{"given":"Minqi","family":"Liao","sequence":"first","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changji","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Electronic Information and Artificial Intelligence, Shaanxi University of Science & Technology","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengyu","family":"Hong","sequence":"additional","affiliation":[{"name":"School of Electronic Information and Artificial Intelligence, Shaanxi University of Science & Technology","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumin","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuande","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Electronic Information and Artificial Intelligence, Shaanxi University of Science & Technology","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanyu","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziying","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahua","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhichao","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhua","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangmin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patience Ratidzo","family":"Ngombengombe","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiongbin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Neurology, Dongguan Xiegang Hospital","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zekui","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Neurology, Dongguan Xiegang Hospital","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanyang","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Puji Campus of Dongguan People\u2019s Hospital","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T. K.","family":"Tam","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong","place":["Hong Kong, Hong Kong SAR, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianping","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern Medical University)","place":["Dongguan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Huang","sequence":"additional","affiliation":[{"name":"Faculty of Electrical Engineering and Computer Science, Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suxia","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dongguan People\u2019s Hospital (The Tenth Affiliated Hospital of Southern 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