Hatani Yutaka, Tanaka Hidekazu, Mochizuki Yasuhide, Hatazawa Keiko, Matsuzoe Hiroki, Shimoura Hiroyuki, Ooka Junichi, Sano Hiroyuki, Sawa Takuma, Motoji Yoshiki, Ryo-Koriyama Keiko, Matsumoto Kensuke, Otake Hiromasa, Shinke Toshiro, Hirata Ken-Ichi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Echocardiography. 2018 Feb;35(2):218-226. doi: 10.1111/echo.13757. Epub 2017 Nov 27.
The closure of atrial septal defect (ASD) results in normalized left ventricular (LV) and right ventricular (RV) geometry, and can increase LV stroke volume (LVSV), but the parameters associated with this increase after the closure of ASD remain uncertain.
Seventy ASD patients, who underwent transcatheter closure, were studied. Their mean age was 57.80 ± 16.88 years, 42 (60%) were female, and LV ejection fraction (LVEF) was 66.76% ± 7.91% (all ≥55%). Transthoracic echocardiography was performed before and 3 months after the procedure. Global longitudinal strain (GLS) was determined as the average peak speckle tracking strain of 18 segments from the 3 standard apical views, LV dispersion was defined as standard deviation of time-to-peak strain from the same views, and RV systolic function was calculated by averaging the 3-regional peak speckle tracking longitudinal strains from the RV free wall. A significant relative increase in LVSV between before and 3 months after the closure was defined as ∆LVSV ≥15%. Twenty age-, gender-, and LVEF-matched controls served as the control group.
Global longitudinal strain (GLS) and RV free wall strain were similar for ASD patients and controls, but LV dispersion in ASD patients was significantly larger. Global longitudinal strain (GLS) remained unchanged after transcatheter closure, whereas RV free wall strain and LV dispersion decreased significantly. An important finding of the multivariate logistic regression analysis showed that ∆LV dispersion was the only independent determinant of increased LVSV after the closure (OR 1.023; 95% CI 1.001-1.046; P < .01).
The assessment of LV dispersion may well have clinical implications for better management of ASD patients after transcatheter closure.
房间隔缺损（ASD）封堵可使左心室（LV）和右心室（RV）几何形态正常化，并可增加左心室每搏输出量（LVSV），但ASD封堵后与这种增加相关的参数仍不确定。
研究了70例行经导管封堵术的ASD患者。他们的平均年龄为57.80±16.88岁，42例（60%）为女性，左心室射血分数（LVEF）为66.76%±7.91%（均≥55%）。在手术前和术后3个月进行经胸超声心动图检查。整体纵向应变（GLS）被确定为来自3个标准心尖视图的18个节段的平均峰值散斑追踪应变，左心室离散度被定义为来自相同视图的峰值应变时间的标准差，右心室收缩功能通过平均右心室游离壁的3个区域峰值散斑追踪纵向应变来计算。封堵前后LVSV的显著相对增加被定义为∆LVSV≥15%。20名年龄、性别和LVEF匹配的对照者作为对照组。
ASD患者和对照组的整体纵向应变（GLS）和右心室游离壁应变相似，但ASD患者的左心室离散度显著更大。经导管封堵后整体纵向应变（GLS）保持不变，而右心室游离壁应变和左心室离散度显著降低。多因素逻辑回归分析的一个重要发现表明，∆左心室离散度是封堵后LVSV增加的唯一独立决定因素（OR 1.023；95%CI 1.001 - 1.046；P <.01）。
左心室离散度的评估可能对经导管封堵术后ASD患者的更好管理具有临床意义。
