Department of Pediatrics Division of Pediatric Cardiology Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands.
Department of Cardiothoracic Surgery Erasmus MC Rotterdam The Netherlands.
J Am Heart Assoc. 2022 Aug 16;11(16):e024072. doi: 10.1161/JAHA.121.024072. Epub 2022 Aug 5.
Background Ventricular performance is temporarily reduced following surgical atrial septal defect closure. Cardiopulmonary bypass and changes in loading conditions are considered important factors, but this phenomenon is incompletely understood. We aim to characterize biventricular performance following surgical and percutaneous atrial septal defect closure and to relate biomarkers to ventricular performance following intervention. Methods and Results In this multicenter prospective study, children scheduled for surgical or percutaneous atrial septal defect closure were included. Subjects were assessed preoperatively, in the second week postintervention (at 2-weeks follow-up), and 1-year postintervention (1-year follow-up). At each time point, an echocardiographic study and a panel of biomarkers were obtained. Sixty-three patients (median age, 4.1 [interquartile range, 3.1-6.1] years) were included. Forty-three patients underwent surgery. At 2-weeks follow-up, right ventricular global longitudinal strain was decreased for the surgical, but not the percutaneous, group (-17.6±4.1 versus -27.1±3.4; <0.001). A smaller decrease was noted for left ventricular global longitudinal strain at 2-weeks follow-up for the surgical group (surgical versus percutaneous, -18.6±3.2 versus -20.2±2.4; =0.040). At 1-year follow-up, left ventricular performance returned to baseline, whereas right ventricular performance improved, but did not reach preintervention levels. Eight biomarkers relating to cardiovascular and immunological processes differed across study time points. Of these biomarkers, only NT-proBNP (N-terminal pro-B-type natriuretic peptide) correlated with less favorable left ventricular global longitudinal strain at 2-weeks follow-up. Conclusions Right, and to a lesser degree left, ventricular performance was reduced early after surgical atrial septal defect closure. Right ventricular performance at 1-year follow-up remained below baseline levels. Several biomarkers showed a pattern over time similar to ventricular performance. These biomarkers may provide insight into the processes that affect ventricular function. Registration URL: https://www.trialregister.nl/; Unique identifier: NL5129.
心脏房间隔缺损修补术后，心室功能会暂时下降。体外循环和负荷条件的变化被认为是重要的影响因素，但这一现象尚未被完全理解。本研究旨在描述心脏房间隔缺损修补术后即刻双心室功能，并探讨干预后生物标志物与心室功能的相关性。
这是一项多中心前瞻性研究，纳入了拟行心脏房间隔缺损修补术的患者。研究对象分别在术前、术后 2 周（2 周随访）和术后 1 年（1 年随访）进行评估，同时进行超声心动图检查和生物标志物检测。共纳入 63 例患者（中位年龄为 4.1 岁[四分位距 3.1~6.1 岁]），其中 43 例接受手术治疗。术后 2 周，手术组右心室整体纵向应变较术前下降（-17.6±4.1 比-27.1±3.4；<0.001），而介入组无此变化。手术组左心室整体纵向应变术后 2 周的下降幅度较小（手术组与介入组相比，-18.6±3.2 比-20.2±2.4；=0.040）。术后 1 年，左心室功能恢复至基线水平，而右心室功能有所改善，但未恢复至术前水平。8 种与心血管和免疫过程相关的生物标志物在不同的研究时间点存在差异。其中，只有 N 末端脑钠肽前体（N-terminal pro-B-type natriuretic peptide，NT-proBNP）与术后 2 周左心室整体纵向应变的恶化程度相关。
心脏房间隔缺损修补术后早期，右心室（一定程度上也包括左心室）功能下降。术后 1 年，右心室功能仍低于基线水平。一些生物标志物的变化模式与心室功能相似。这些生物标志物可能为影响心室功能的机制提供新的认识。
