Yamano Michiyo, Yamano Tetsuhiro, Nakamura Takeshi, Zen Kan, Shiraishi Hirokazu, Shirayama Takeshi, Matoba Satoaki
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan.
Circ Rep. 2020 Jan 23;2(2):113-120. doi: 10.1253/circrep.CR-19-0128.
The aim of this study was to identify factors of left ventricular filling pressure (LVFP) elevation following transcatheter atrial septal defect (ASD) closure. The study involved 97 adult patients with sinus rhythm who underwent both transcatheter ASD closure and transthoracic echocardiography. Elevated LVFP was diagnosed during the first month of follow-up according to the American Society of Echocardiography guidelines: that is, ratio of transmitral early filling to the lateral annular diastolic velocity (lateral E/e') >13 was used to exclude the effect of the device on the atrial septum. Fifteen patients (15.5%) were diagnosed with increased LVFP during the 1-month follow-up period (median lateral E/e': from 9.2, IQR, 6.6-10.8; to 15.5, IQR, 13.8-17.8; P<0.001). Independent predictors of LVFP elevation were left ventricular (LV) relative wall thickness, lateral E/e›, and peak tricuspid regurgitation pressure gradient (TRPG) at baseline (OR, 1.67; 95% CI: 1.04-2.69; OR, 1.52; 95% CI: 1.07-2.15; and OR, 1.14; 95% CI: 1.04-1.25; cut-offs: 0.42, 7.5, and 27.0 mmHg, respectively). Median lateral E/e› returned to baseline in most patients with LVFP elevation during 6 months of subsequent follow-up (1-month-6-month follow-up: 15.5, IQR, 13.8-17.8; 11.1, IQR, 8.8-14.8, respectively; P=0.001). The increase in Doppler-estimated LVFP following transcatheter ASD closure may be related to LV hypertrophy, diastolic dysfunction, and peak TRPG in elderly patients.
本研究的目的是确定经导管房间隔缺损（ASD）封堵术后左心室充盈压（LVFP）升高的因素。该研究纳入了97例接受经导管ASD封堵术和经胸超声心动图检查的窦性心律成年患者。根据美国超声心动图学会指南，在随访的第一个月内诊断LVFP升高：即二尖瓣早期充盈与侧方瓣环舒张期速度之比（侧方E/e'）>13，以排除封堵装置对房间隔的影响。15例患者（15.5%）在1个月的随访期内被诊断为LVFP升高（侧方E/e'中位数：从9.2，四分位数间距，6.6 - 10.8；升至15.5，四分位数间距，13.8 - 17.8；P<0.001）。LVFP升高的独立预测因素为基线时的左心室（LV）相对壁厚、侧方E/e›和三尖瓣反流峰值压力梯度（TRPG）（比值比，1.67；95%置信区间：1.04 - 2.69；比值比，1.52；95%置信区间：1.07 - 2.15；以及比值比，1.14；95%置信区间：1.04 - 1.25；截断值分别为0.42、7.5和27.0 mmHg）。在随后6个月的随访中，大多数LVFP升高的患者侧方E/e›中位数恢复至基线水平（1个月至6个月随访：分别为15.5，四分位数间距，13.8 - 17.8；11.1，四分位数间距，8.8 - 14.8；P = 0.001）。经导管ASD封堵术后多普勒估计的LVFP升高可能与老年患者的LV肥厚、舒张功能障碍和TRPG峰值有关。
