Jin X, Hummel Y M, Tay W T, Nauta J F, Bamadhaj N S S, van Melle J P, Lam C S P, Voors A A, Hoendermis E S
National Heart Centre Singapore, Singapore, Singapore.
Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Neth Heart J. 2021 Jul;29(7-8):402-408. doi: 10.1007/s12471-021-01543-0. Epub 2021 Feb 16.
Transcatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure might have opposite short- and long-term haemodynamic consequences compared with restricted interatrial shunt creation, which recently emerged as a potential treatment modality for patients with heart failure with preserved ejection fraction (HFpEF). Given the opposing approaches of ASD and PFO closure versus shunt creation, we investigated the early and sustained cardiac structural and functional changes following transcatheter ASD or PFO closure.
In this retrospective study, adult secundum-type ASD and PFO patients with complete echocardiography examinations at baseline and at 1‑day and 1‑year follow-up who also underwent transcatheter closure between 2013 and 2017 at the University Medical Centre Groningen, the Netherlands were included.
Thirty-nine patients (mean age 48 ± standard deviation 16 years, 61.5% women) were included. Transcatheter ASD/PFO closure resulted in an early and persistent decrease in right ventricular systolic and diastolic function. Additionally, transcatheter ASD/PFO closure resulted in an early and sustained favourable response of left ventricular (LV) systolic function, but also in deterioration of LV diastolic function with an increase in LV filling pressure (LVFP), as assessed by echocardiography. Age (β = 0.31, p = 0.009) and atrial fibrillation (AF; β = 0.24, p = 0.03) were associated with a sustained increase in LVFP after transcatheter ASD/PFO closure estimated by mean E/e' ratio (i.e. ratio of mitral peak velocity of early filling to diastolic mitral annular velocity). In subgroup analysis, this was similar for ASD and PFO closure.
Older patients and patients with AF were predisposed to sustained increases in left-sided filling pressures resembling HFpEF following ASD or PFO closure. Consequently, these findings support the current concept that creating a restricted interatrial shunt might be beneficial, particularly in elderly HFpEF patients with AF.
与限制性房间隔分流术相比，经导管房间隔缺损（ASD）和卵圆孔未闭（PFO）封堵术可能会产生相反的短期和长期血流动力学后果，而限制性房间隔分流术最近已成为射血分数保留的心力衰竭（HFpEF）患者的一种潜在治疗方式。鉴于ASD和PFO封堵术与分流术的相反方法，我们研究了经导管ASD或PFO封堵术后早期和持续的心脏结构和功能变化。
在这项回顾性研究中，纳入了2013年至2017年在荷兰格罗宁根大学医学中心接受经导管封堵术的继发孔型ASD和PFO成年患者，这些患者在基线、术后1天和1年随访时均进行了完整的超声心动图检查。
共纳入39例患者（平均年龄48±标准差16岁，61.5%为女性）。经导管ASD/PFO封堵术导致右心室收缩和舒张功能早期和持续下降。此外，经导管ASD/PFO封堵术导致左心室（LV）收缩功能早期和持续的良好反应，但也导致LV舒张功能恶化，LV充盈压（LVFP）升高，这通过超声心动图评估。年龄（β = 0.31，p = 0.009）和心房颤动（AF；β = 0.24，p = 0.03）与经导管ASD/PFO封堵术后LVFP持续升高相关，通过平均E/e'比值（即二尖瓣早期充盈峰值速度与二尖瓣舒张期环速度之比）估计。在亚组分析中，ASD和PFO封堵术的情况相似。
老年患者和AF患者在ASD或PFO封堵术后易出现类似于HFpEF的左侧充盈压持续升高。因此，这些发现支持了目前的概念，即建立限制性房间隔分流可能有益，特别是在患有AF的老年HFpEF患者中。
