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

• Published in: The International Journal of Cardiovascular Imaging Vol. 37; no. 10; pp. 2931 - 2941
• Main Authors: Suzuki, Makiko, Matsumoto, Kensuke, Tanaka, Yusuke, Yamashita, Kentaro, Shono, Ayu, Sumimoto, Keiko, Shibata, Nao, Yokota, Shun, Suto, Makiko, Dokuni, Kumiko, Tanaka, Hidekazu, Otake, Hiromasa, Hirata, Ken-ichi
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.10.2021; Springer Nature B.V
• Subjects: Blood pressure; Cardiac Imaging; Cardiology; Confidence intervals; Coupling; Heart; Imaging; Medicine; Medicine & Public Health; Multivariate analysis; Original Paper; Pulmonary arteries; Pulmonary artery; Radiology; Systolic pressure; Ventricle; Heart failure; Atrial septal defect; Myocardial deformation; Residual symptom; Ventriculo-arterial coupling; Right ventricle
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-021-02282-4

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.