Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjajaran, Jalan Pasteur No 38, Pasteur, Bandung, Jawa Barat, Bandung, Indonesia.
Department of Child Health, Faculty of Medicine, University of Padjajaran, Bandung, Indonesia.
BMC Cardiovasc Disord. 2024 Jun 10;24(1):297. doi: 10.1186/s12872-024-03935-7.
Atrial septal defects (ASD) are the most common type of adult congenital heart disease (ACHD) associated with a high risk developing of pulmonary arterial hypertension (PAH). ASD closure is not recommended in patients with PAH and Pulmonary Vascular Resistance (PVR) ≥ 5 Wood Unit (WU). Noninvasive methods have been proposed to measure PVR; however, their accuracy remains low. Right Ventricle (RV) - Pulmonary Artery (PA) coupling is defined as the ability of the RV to adapt to high-resistance conditions. Tricuspid Annular Plane Systolic Excursion (TAPSE)/estimated pulmonary artery systolic pressure (ePASP) calculation using echocardiography is a noninvasive technique that has been proposed as a surrogate equation to evaluate RV-PA coupling. Currently, no research has demonstrated a relationship between RV-PA coupling and PVR in patients with ASD.
The study participants were consecutive eligible patients with ASD who underwent right heart catheterization (RHC) and echocardiography at Hasan Sadikin General Hospital, Bandung. Both the procedures were performed on the same day. RV-PA Coupling, defined as TAPSE/ePASP > 0.31, was assessed using echocardiography. The PVR was calculated during RHC using the indirect Fick method.
There were 58 patients with ASD underwent RHC and echocardiography. Among them, 18 had RV/PA Coupling and 40 had RV/PA Uncoupling. The PVR values were significantly different between the two groups (p = 0.000). Correlation test between TAPSE/ePASP with PVR showed moderate negative correlation (r= -0.502, p = 0.001). TAPSE/ePASP ≤ 0.34 is the cutoff point to predict PVR > 5 WU with sensitivity of 91.7% and specificity 63.6%.
This study showed a moderate negative correlation between TAPSE/ePASP and PVR. TAPSE/ePASP ≤ 0.34 could predict PVR > 5 WU with good sensitivity.
房间隔缺损（ASD）是最常见的成人先天性心脏病（ACHD）类型，与肺动脉高压（PAH）的高风险相关。不建议在 PAH 患者和肺血管阻力（PVR）≥5 伍德单位（WU）的患者中进行 ASD 闭合。已经提出了一些非侵入性方法来测量 PVR；然而，它们的准确性仍然较低。右心室（RV）-肺动脉（PA）耦合被定义为 RV 适应高阻力条件的能力。使用超声心动图计算三尖瓣环平面收缩期位移（TAPSE）/估计肺动脉收缩压（ePASP）是一种非侵入性技术，已被提出作为评估 RV-PA 耦合的替代方程。目前，尚无研究表明 ASD 患者的 RV-PA 耦合与 PVR 之间存在关系。
本研究的参与者是连续符合条件的在万隆 Hasan Sadikin 综合医院接受右心导管检查（RHC）和超声心动图检查的 ASD 患者。这两个程序都是在同一天进行的。使用超声心动图评估 RV-PA 耦合，定义为 TAPSE/ePASP＞0.31。使用间接 Fick 法在 RHC 期间计算 PVR。
共有 58 例 ASD 患者接受了 RHC 和超声心动图检查。其中，18 例有 RV/PA 耦合，40 例有 RV/PA 不耦合。两组之间的 PVR 值有显著差异（p=0.000）。TAPSE/ePASP 与 PVR 的相关测试显示中度负相关（r=-0.502，p=0.001）。TAPSE/ePASP≤0.34 是预测 PVR＞5 WU 的截断点，灵敏度为 91.7%，特异性为 63.6%。
本研究显示 TAPSE/ePASP 与 PVR 之间存在中度负相关。TAPSE/ePASP≤0.34 可以预测 PVR＞5 WU，具有良好的灵敏度。
