Influence of Left Ventricular Stiffness on Hemodynamics in Patients With Untreated Atrial Septal Defects

• Published in: Circulation Journal Vol. 79; no. 8; pp. 1823 - 1827
• Main Authors: Inuzuka, Ryo, Kuwata, Seiko, Ishido, Hirotaka, Saiki, Hirofumi, Kurishima, Clara, Iwamoto, Yoichi, Sugimoto, Masaya, Masutani, Satoshi, Senzaki, Hideaki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2015
• Subjects: Adolescent; Adult; Aged; Cardiac catheterization; Child; Child, Preschool; Congenital heart defects; Female; Heart Septal Defects - physiopathology; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Models, Cardiovascular; Vascular Resistance
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-14-1351

Background:Although left ventricular (LV) stiffening with age is believed to increase left-to-right shunting in patients with atrial septal defects (ASD), clinical data have not confirmed this. We sought determinants of the pulmonary-to-systemic flow ratio (Qp/Qs) in patients with untreated ASD.Methods and Results:We retrospectively studied 180 patients with ASD who underwent percutaneous ASD closure between 2007 and 2011. Qp/Qs and LV stiffness were measured before ASD closure.The median age of the subjects was 18 years, and 117 (65.0%) were female. The mean ASD size adjusted for square root of body surface area (BSA) was 14.4±4.2 mm/m, and the Qp/Qs was 2.28±0.74. Adjusted ASD size most strongly related to Qp/Qs (r=0.74, P<0.0001). Multivariate analysis revealed that LV stiffness was a significant predictor of Qp/Qs, independently of adjusted ASD size and vascular resistance (P=0.0015). Based on the multivariate model that accounts for the effects of LV stiffness and vascular resistance, the minimal adjusted diameter that can cause a Qp/Qs of 2.0 was predicted to be 7.3 mm/m.Conclusions:Qp/Qs in ASD can change significantly depending on LV stiffness, suggesting that it would increase with age. An ASD >7.3 mm/m in diameter has the potential to cause significant left-to-right shunting, and may require closure regardless of hemodynamic status at the time of assessment. (Circ J 2015; 79: 1823–1827)