論文

国際誌
2021年5月15日

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

The international journal of cardiovascular imaging
  • 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

記述言語
英語
掲載種別
研究論文(学術雑誌)
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.

リンク情報
DOI
https://doi.org/10.1007/s10554-021-02282-4
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/33993433
ID情報
  • DOI : 10.1007/s10554-021-02282-4
  • PubMed ID : 33993433

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