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Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect
BACKGROUND: Functional tricuspid regurgitation (TR) usually decreases after atrial septal defect (ASD) closure; however, it may persist and cause heart failure that requires treatment. We aimed to investigate clinical and echocardiographic factors predicting persistent TR after ASD closure. METHODS:...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9702057/ https://www.ncbi.nlm.nih.gov/pubmed/36451927 http://dx.doi.org/10.3389/fcvm.2022.896711 |
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author | Lee, Seon Hwa Shin, Yu Rim Kim, Dae-Young Seo, Jiwon Cho, Iksung Lee, Sak Kim, Jung Sun Hong, Geu-Ru Ha, Jong-Won Shim, Chi Young |
author_facet | Lee, Seon Hwa Shin, Yu Rim Kim, Dae-Young Seo, Jiwon Cho, Iksung Lee, Sak Kim, Jung Sun Hong, Geu-Ru Ha, Jong-Won Shim, Chi Young |
author_sort | Lee, Seon Hwa |
collection | PubMed |
description | BACKGROUND: Functional tricuspid regurgitation (TR) usually decreases after atrial septal defect (ASD) closure; however, it may persist and cause heart failure that requires treatment. We aimed to investigate clinical and echocardiographic factors predicting persistent TR after ASD closure. METHODS: Among 348 adults who underwent isolated ASD closure between January 2010 and September 2020, 91 (26.1%) patients with significant TR (at least moderate degree) before ASD closure were included. Persistent TR was defined as significant TR on echocardiography at 6 months to 1 year after ASD correction. We comprehensively analyzed the echocardiogram before ASD closure, including speckle-tracking imaging. Right ventricular (RV)–pulmonary arterial (PA) (RV–PA) coupling was assessed by the ratio of RV global longitudinal strain (RV GLS) and tricuspid annular S' velocity to PA systolic pressure (PASP). RESULTS: Persistent TR was observed in 22 (24.2%) patients. Patients with persistent TR were significantly older and had larger TR jet areas and lower RV–PA coupling parameters than those without persistent TR. On multivariable regression, persistent TR was independently associated with age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01–1.14, p = 0.030) and |RV GLS|/PASP (OR 0.001, 95% CI 0.00–0.017, p = 0.012). ROC curves analysis showed that |RV GLS|/PASP's best cut-off for persistent TR was 0.46 (cut-off 0.46, the area under the curve 0.789, p < 0.001). CONCLUSION: Persistent TR after ASD closure is not rare. Old age and RV–PA uncoupling could be associated with persistent TR after ASD closure. In older patients with abnormal RV–PA coupling, careful evaluation and concomitant or subsequent TR intervention may be considered. |
format | Online Article Text |
id | pubmed-9702057 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97020572022-11-29 Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect Lee, Seon Hwa Shin, Yu Rim Kim, Dae-Young Seo, Jiwon Cho, Iksung Lee, Sak Kim, Jung Sun Hong, Geu-Ru Ha, Jong-Won Shim, Chi Young Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Functional tricuspid regurgitation (TR) usually decreases after atrial septal defect (ASD) closure; however, it may persist and cause heart failure that requires treatment. We aimed to investigate clinical and echocardiographic factors predicting persistent TR after ASD closure. METHODS: Among 348 adults who underwent isolated ASD closure between January 2010 and September 2020, 91 (26.1%) patients with significant TR (at least moderate degree) before ASD closure were included. Persistent TR was defined as significant TR on echocardiography at 6 months to 1 year after ASD correction. We comprehensively analyzed the echocardiogram before ASD closure, including speckle-tracking imaging. Right ventricular (RV)–pulmonary arterial (PA) (RV–PA) coupling was assessed by the ratio of RV global longitudinal strain (RV GLS) and tricuspid annular S' velocity to PA systolic pressure (PASP). RESULTS: Persistent TR was observed in 22 (24.2%) patients. Patients with persistent TR were significantly older and had larger TR jet areas and lower RV–PA coupling parameters than those without persistent TR. On multivariable regression, persistent TR was independently associated with age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01–1.14, p = 0.030) and |RV GLS|/PASP (OR 0.001, 95% CI 0.00–0.017, p = 0.012). ROC curves analysis showed that |RV GLS|/PASP's best cut-off for persistent TR was 0.46 (cut-off 0.46, the area under the curve 0.789, p < 0.001). CONCLUSION: Persistent TR after ASD closure is not rare. Old age and RV–PA uncoupling could be associated with persistent TR after ASD closure. In older patients with abnormal RV–PA coupling, careful evaluation and concomitant or subsequent TR intervention may be considered. Frontiers Media S.A. 2022-11-14 /pmc/articles/PMC9702057/ /pubmed/36451927 http://dx.doi.org/10.3389/fcvm.2022.896711 Text en Copyright © 2022 Lee, Shin, Kim, Seo, Cho, Lee, Kim, Hong, Ha and Shim. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Lee, Seon Hwa Shin, Yu Rim Kim, Dae-Young Seo, Jiwon Cho, Iksung Lee, Sak Kim, Jung Sun Hong, Geu-Ru Ha, Jong-Won Shim, Chi Young Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect |
title | Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect |
title_full | Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect |
title_fullStr | Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect |
title_full_unstemmed | Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect |
title_short | Clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect |
title_sort | clinical significance of right ventricular–pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9702057/ https://www.ncbi.nlm.nih.gov/pubmed/36451927 http://dx.doi.org/10.3389/fcvm.2022.896711 |
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