Alkhateeb Areej, Roushdy Alaa, Hasan-Ali Hosam, Kishk Yehia Taha, Hassan Ayman K M
Cardiology Division of Internal Medicine Department, South Valley University Hospital, Qena, 83523, Egypt.
King's College London, London, UK.
Egypt Heart J. 2020 Dec 9;72(1):85. doi: 10.1186/s43044-020-00120-x.
The trans-catheter closure of atrial septal defect (ASD) usually has a rapid impact on biventricular remodelling and functions. Whether the transcatheter closure of ASD at early childhood or at adulthood age would affect the improvement in biventricular dimensions and functions remains an area of active research.
This prospective observational study enrolled 70 subjects (50 ASD cases and 20 control subjects). Tissue Doppler imaging (TDI) and strain (S) were performed for the control group and ASD patients at baseline and at 24 h and 1 month after ASD device closure. The total ASD group was subdivided into two subgroups: group-1-children and adolescent with ASD, who underwent transcatheter closure at age ≤ 19 years; group-2-adult who underwent ASD device closure at age > 19 years old. The right and left ventricular global longitudinal systolic strain (RV/LV-GLS) and RV free wall longitudinal strain (RV free wall LS) showed a significant decline after 24 h of device closure (RVGLS-P = 0.001, LVGLS-P = 0.048, RV free wall LS-P < 0.001). However, after a 1-month follow-up, the LVGLS increased in comparison with 24 h changes after device closure (P = 0.038). The baseline mean value of RV free wall LS of G2 was significantly lower than G1 value (P < 0.001). There was no statistically significant difference between the 2 age subgroups regarding biventricular GLS and RV free wall LS changes after device closure. The changes in LV diastolic function immediately and after 1 month of device closure showed a statistically significant change in e' and its delta change value in group-2 in comparison with its baseline values and to group-1 delta changes (P = 0.002, P = 0.011, P = 0.019, respectively).
The ASD transcatheter closure reduced biventricular global and RV free wall longitudinal systolic strain within 1 day of intervention and was associated with a short-term improvement in the LV-GLSS after a 1-month duration. The progressive increase in LV preload results in its strain growth and reduction in diastolic function after transcatheter ASD closure. The older age at the time of ASD device closure was associated with a significant decrease in the RV free wall LS and septal e' velocity towards abnormality.
经导管封堵房间隔缺损（ASD）通常会对双心室重塑和功能产生迅速影响。在儿童期或成年期进行ASD经导管封堵是否会影响双心室大小和功能的改善仍是一个活跃的研究领域。
这项前瞻性观察性研究纳入了70名受试者（50例ASD患者和20名对照受试者）。在基线、ASD封堵装置置入后24小时和1个月时，对对照组和ASD患者进行组织多普勒成像（TDI）和应变（S）测量。将整个ASD组分为两个亚组：1组为年龄≤19岁接受经导管封堵的ASD儿童和青少年；2组为年龄>19岁接受ASD封堵装置置入的成年人。封堵装置置入24小时后，右心室和左心室整体纵向收缩期应变（RV/LV-GLS）以及右心室游离壁纵向应变（RV游离壁LS）显著下降（RVGLS-P = 0.001，LVGLS-P = 0.048，RV游离壁LS-P < 0.001）。然而，在1个月的随访后，与封堵装置置入后24小时的变化相比，LVGLS有所增加（P = 0.038）。2组RV游离壁LS的基线平均值显著低于1组（P < 0.001）。在封堵装置置入后，两个年龄亚组在双心室GLS和RV游离壁LS变化方面无统计学显著差异。封堵装置置入即刻和1个月后左心室舒张功能的变化显示，与基线值相比，2组的e'及其变化差值有统计学显著变化，与1组的变化差值相比也有统计学显著变化（分别为P = 0.002、P = 0.011、P = 0.019）。
ASD经导管封堵在干预1天内降低了双心室整体和右心室游离壁纵向收缩期应变，并与1个月后左心室-GLSS的短期改善相关。经导管ASD封堵后左心室前负荷的逐渐增加导致其应变增加和舒张功能降低。ASD封堵装置置入时年龄较大与右心室游离壁LS显著降低和间隔e'速度趋向异常有关。
