Nassif Martina, van Steenwijk Reindert P, Hogenhout Jacqueline M, Lu Huangling, de Bruin-Bon Rianne H A C M, Hirsch Alexander, Sterk Peter J, Bouma Berto J, Straver Bart, Tijssen Jan G P, Mulder Barbara J M, de Winter Robbert J
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Congenit Heart Dis. 2018 Nov;13(6):959-966. doi: 10.1111/chd.12665. Epub 2018 Sep 21.
The association between secundum atrial septal defects (ASD) and asthma-like dyspnea with consequent long-term pulmonary inhalant use, is poorly understood in adult ASD patients. Airway hyperresponsiveness is suggested to be the underlying mechanism of cardiac asthma from mitral valve disease and ischemic cardiomyopathy. We hypothesized that airway hyperresponsiveness may also be found in adult ASD patients. Our aim was to study airway responsiveness in adult ASD patients before percutaneous closure and at short-and long-term postprocedural follow-up.
This prospective study included 31 ASD patients (65% female, mean age 49 ± 15y) who underwent spirometry and bronchoprovocation testing pre-and six-month postprocedurally, with additional bronchoprovocation at 2-year follow-up. Airway hyperresponsiveness was defined as ≥20% fall of forced expiratory volume in 1-second (FEV ) following <8.0 mg/mL of inhaled methacholine.
Airway hyperresponsiveness was found in 19/30 patients (63%[95%CI 45%-81%]; post hoc statistical power = 89%). Asthma-like symptoms wheezing, chest tightness, and cough were more frequently reported in airway hyperresponsive patients. Airway responsiveness was not influenced by successful percutaneous ASD closure, corresponding to persistence of asthma-like symptoms postclosure. Regardless of airway responsiveness, postprocedural right-sided reverse remodeling significantly improved dyspnea and pulmonary function.
This study is the first to report a high prevalence of airway hyperresponsiveness in a cohort of unrepaired adult ASD patients, and confirms the association between asthma-like symptoms and ASD in adults. Attention to symptoms and pulmonary function should be given during clinical follow-up of adult ASD patients, both before and long after repair.
继发孔型房间隔缺损（ASD）与哮喘样呼吸困难及随后长期使用肺部吸入药物之间的关联，在成年ASD患者中尚不清楚。气道高反应性被认为是二尖瓣疾病和缺血性心肌病所致心源性哮喘的潜在机制。我们推测成年ASD患者中也可能存在气道高反应性。我们的目的是研究成年ASD患者在经皮封堵术前以及术后短期和长期随访时的气道反应性。
这项前瞻性研究纳入了31例ASD患者（65%为女性，平均年龄49±15岁），他们在术前及术后6个月接受了肺活量测定和支气管激发试验，并在2年随访时再次进行支气管激发试验。气道高反应性定义为吸入乙酰甲胆碱<8.0mg/mL后1秒用力呼气容积（FEV）下降≥20%。
30例患者中有19例（63%[95%CI 45%-81%]；事后检验统计功效=89%）存在气道高反应性。气道高反应性患者更频繁地报告有哮喘样症状，如喘息、胸闷和咳嗽。气道反应性不受经皮ASD封堵成功的影响，这与封堵术后哮喘样症状持续存在一致。无论气道反应性如何，术后右侧逆向重构均显著改善了呼吸困难和肺功能。
本研究首次报告了一组未经修复的成年ASD患者中气道高反应性的高患病率，并证实了成年人中哮喘样症状与ASD之间的关联。在成年ASD患者临床随访期间，无论术前还是修复后很长时间，都应关注症状和肺功能。
