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The International Journal of Cardiovascular Imaging

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01-10-2021 | Atrial Septal Defect | Original Paper

Preoperative coupling between right ventricle and pulmonary vasculature is an important determinant of residual symptoms after the closure of atrial septal defect

Authors: Makiko Suzuki, Kensuke Matsumoto, Yusuke Tanaka, Kentaro Yamashita, Ayu Shono, Keiko Sumimoto, Nao Shibata, Shun Yokota, Makiko Suto, Kumiko Dokuni, Hidekazu Tanaka, Hiromasa Otake, Ken-ichi Hirata

Published in: The International Journal of Cardiovascular Imaging | Issue 10/2021

Abstract

Purposes

The closure of atrial septal defect (ASD) is associated with a significant reduction in right ventricular (RV) overload and an improvement in functional capacity in most adults with ASD. However, a subset of patients remains symptomatic even after closure due to therapeutic delay. To date, no clinically robust preoperative predictor of postoperative residual symptoms has been clearly identified.

Methods

In this study, 120 adult patients with ASD and 39 controls were investigated. As an index of RV myocardial deformation, RV global longitudinal strain (RV-GLS) was evaluated. The degree of coupling between RV and pulmonary artery (PA) was quantified by the tricuspid annular plane systolic excursion (TAPSE) divided by the PA systolic pressure (PASP).

Results

Compared to controls, baseline RV-GLS was significantly greater (− 27 ± 7 vs. − 23 ± 5%, P = 0.02) and TAPSE/PASP ratio was severely impaired (0.8 ± 0.3 vs. 2.1 ± 1.6 mm/mmHg, P < 0.01) in ASD patients. At 6 months after closure, 15 patients (12.5%) remained symptomatic. In patients without residual symptoms, TAPSE/PASP ratio significantly improved from 0.9 ± 0.3 to 1.0 ± 0.6 mm/mmHg (P = 0.02), and RV-GLS normalized (from − 28 ± 11 to − 24 ± 7%, P < 0.01) after closure. However, RV-GLS and TAPSE/PASP ratio showed no significant change in ASD patients with residual symptoms. On multivariate analysis, preoperative TAPSE/PASP ratio (odds ratio [OR] 0.034, 95% confidence interval [CI] 0.000–0.604, P = 0.03) and pulmonary vascular resistance index ([PVRI], OR 1.011, 95% CI 1.000–1.021, P < 0.05) were associated with the postoperative symptomatic status.

Conclusion

In terms of integrated assessment of the RV-PA unit, preoperative TAPSE/PASP ratio and PVRI were important determinants of residual symptoms after ASD closure.

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Title: Preoperative coupling between right ventricle and pulmonary vasculature is an important determinant of residual symptoms after the closure of atrial septal defect
Authors: Makiko Suzuki
Kensuke Matsumoto
Yusuke Tanaka
Kentaro Yamashita
Ayu Shono
Keiko Sumimoto
Nao Shibata
Shun Yokota
Makiko Suto
Kumiko Dokuni
Hidekazu Tanaka
Hiromasa Otake
Ken-ichi Hirata
Publication date: 01-10-2021
Publisher: Springer Netherlands
Keywords: Atrial Septal Defect
Atrial Septal Defect
Published in: The International Journal of Cardiovascular Imaging / Issue 10/2021
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-021-02282-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative coupling between right ventricle and pulmonary vasculature is an important determinant of residual symptoms after the closure of atrial septal defect

Abstract

Purposes

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purposes

Methods

Results

Conclusion

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