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Transcatheter closure of atrial septal defect in adults : time-course of atrial and ventricular remodeling and effects on exercise capacity

Stephensen, Sigurdur S. LU ; Ostenfeld, Ellen LU ; Kutty, Shelby ; Steding-Ehrenborg, Katarina LU ; Arheden, Hakan LU ; Thilén, Ulf LU and Carlsson, Marcus LU (2019) In International Journal of Cardiovascular Imaging
Abstract

Investigate ventricular and atrial remodeling following atrial septal defect (ASD) closure and examine if pulmonary-to-systemic flow ratio (QP/QS) and right ventricular (RV) volume predict improvement, determined as percentage of predicted oxygen uptake (VO2%). Long-term cardiovascular magnetic resonance (CMR) data on atrial and ventricular remodeling after ASD-closure is limited and treatment effect on exercise capacity is debated. Sixteen patients undergoing transcatheter ASD closure and 16 age and sexmatched controls were studied. CMR was performed before treatment, the day after and 3 and 12 months later. Exercise test with gas analysis was performed before and 12 months after treatment. QP/QS decreased from 2.1 ± 0.5 to... (More)

Investigate ventricular and atrial remodeling following atrial septal defect (ASD) closure and examine if pulmonary-to-systemic flow ratio (QP/QS) and right ventricular (RV) volume predict improvement, determined as percentage of predicted oxygen uptake (VO2%). Long-term cardiovascular magnetic resonance (CMR) data on atrial and ventricular remodeling after ASD-closure is limited and treatment effect on exercise capacity is debated. Sixteen patients undergoing transcatheter ASD closure and 16 age and sexmatched controls were studied. CMR was performed before treatment, the day after and 3 and 12 months later. Exercise test with gas analysis was performed before and 12 months after treatment. QP/QS decreased from 2.1 ± 0.5 to 1.4 ± 0.3 at day 1 and 1.1 ± 0.1 at 3 and 12 months. Left ventricular (LV) volumes increased and normalized on day 1 whereas left atrial volumes were unchanged. RV and right atrial volumes decreased the first 3 months. LV and RV volumes had not equalized at 12 months (RV/LV ratio 1.2 ± 0.1, P < 0.01) and RV ejection fraction remained decreased compared to controls. Improvement of VO2% after ASD closure (P < 0.01) was inversely related to QP/QS at rest (r = − 0.56, P < 0.05) but unrelated to RV end-diastolic volume (P = 0.16). Following transcatheter ASD closure, LV adaptation is rapid and RV adaptation is prolonged, with decreased systolic RV function. Patients with smaller shunts had larger improvement in VO2% suggesting patients with defects of borderline hemodynamic significance might benefit from closure. This may be due to impaired LV diastolic function influencing shunt size and exercise capacity following ASD closure.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
ASD, Congenital heart disease, Exercise capacity, Heart failure, MRI
in
International Journal of Cardiovascular Imaging
publisher
Springer
external identifiers
  • scopus:85067700504
ISSN
1569-5794
DOI
10.1007/s10554-019-01647-0
language
English
LU publication?
yes
id
42bb7da6-1d2f-49ad-86cf-0d2f75221adc
date added to LUP
2019-07-08 13:00:50
date last changed
2019-11-25 09:32:53
@article{42bb7da6-1d2f-49ad-86cf-0d2f75221adc,
  abstract     = {<p>Investigate ventricular and atrial remodeling following atrial septal defect (ASD) closure and examine if pulmonary-to-systemic flow ratio (QP/QS) and right ventricular (RV) volume predict improvement, determined as percentage of predicted oxygen uptake (VO<sub>2</sub>%). Long-term cardiovascular magnetic resonance (CMR) data on atrial and ventricular remodeling after ASD-closure is limited and treatment effect on exercise capacity is debated. Sixteen patients undergoing transcatheter ASD closure and 16 age and sexmatched controls were studied. CMR was performed before treatment, the day after and 3 and 12 months later. Exercise test with gas analysis was performed before and 12 months after treatment. QP/QS decreased from 2.1 ± 0.5 to 1.4 ± 0.3 at day 1 and 1.1 ± 0.1 at 3 and 12 months. Left ventricular (LV) volumes increased and normalized on day 1 whereas left atrial volumes were unchanged. RV and right atrial volumes decreased the first 3 months. LV and RV volumes had not equalized at 12 months (RV/LV ratio 1.2 ± 0.1, P &lt; 0.01) and RV ejection fraction remained decreased compared to controls. Improvement of VO<sub>2</sub>% after ASD closure (P &lt; 0.01) was inversely related to QP/QS at rest (r = − 0.56, P &lt; 0.05) but unrelated to RV end-diastolic volume (P = 0.16). Following transcatheter ASD closure, LV adaptation is rapid and RV adaptation is prolonged, with decreased systolic RV function. Patients with smaller shunts had larger improvement in VO<sub>2</sub>% suggesting patients with defects of borderline hemodynamic significance might benefit from closure. This may be due to impaired LV diastolic function influencing shunt size and exercise capacity following ASD closure.</p>},
  author       = {Stephensen, Sigurdur S. and Ostenfeld, Ellen and Kutty, Shelby and Steding-Ehrenborg, Katarina and Arheden, Hakan and Thilén, Ulf and Carlsson, Marcus},
  issn         = {1569-5794},
  language     = {eng},
  publisher    = {Springer},
  series       = {International Journal of Cardiovascular Imaging},
  title        = {Transcatheter closure of atrial septal defect in adults : time-course of atrial and ventricular remodeling and effects on exercise capacity},
  url          = {http://dx.doi.org/10.1007/s10554-019-01647-0},
  doi          = {10.1007/s10554-019-01647-0},
  year         = {2019},
}