Impaired left and right systolic ventricular capacity in corrected atrial septal defect patients

Abstract

Resting right ventricular (RV) systolic function has in some studies been shown to be impaired after correction of an atrial septal defect (ASD) whereas impairment of left ventricular (LV) systolic function is uncertain. In the present study we examine the LV and RV systolic response to exercise in patients with a previously corrected ASD in order to investigate the myocardial capacity. Thirty-six adult ASD patients with a corrected isolated secundum ASD and eighteen adult age-matched controls underent a semi-supine exercise stress echocardiographic examination. At rest, LV parameters were comparable between groups, and RV global longitudinal strain (RV-GLS) was lower for the ASD group (−18.5%, 95% CI −20.0—−17.0%) compared with controls (−24.5%, 95% CI −27.7—−22.4%, p < 0.001). At peak exercise, LV ejection fraction (LVEF) was lower for ASD patients (61%, 95% CI 58–65%) compared with controls (68%, 95% CI 64–73% p = 0.01). Peak LV global longitudinal strain (LV-GLS) was borderline significantly lower (ASD: -18.4%, 95% CI −20.2—−16.6%, controls: −21.3%, 95% CI −23.6—−19.0%, p = 0.059). Both RVEF (ASD: 64%, 95% CI 60–68%, controls: 73%, 95% CI 65–80%, p = 0.05) and tricuspid annular plane systolic excursion (TAPSE) (ASD: 2.5 cm, 95% CI 2.3–2.7 cm, controls: 3.2 cm, 95% CI 2.9–3.6 cm, p < 0.001) at peak exercise were lower for ASD patients. Exercise assessed peak oxygen uptake was comparable between groups (ASD: 32.8 mL O2/kg/min, 95% CI 30.3–35.5 mL O2/kg/min, controls: 35.2 mL O2/kg/min, 95% CI 31.6–38.8 mL O2/kg/min, p = 0.3). Corrected ASD patients demonstrate a reduced LV and RV systolic exercise response decades after ASD correction whereas resting parameters of LV and RV systolic function were within normal range. The presence of subclinical systolic myocardial dysfunction during exercise might be associated with the long-term morbidities documented in this patient group.

Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery

“…LV systolic function was diminished in 10%, while in literature, LVEF and global longitudinal strain are within normal range after ASDcorrection in adults [34]. However, recently a reduced LV and RV systolic response to exercise was described in subjects decades after ASD correction who had normal resting function parameters [35]. Despite the observed suboptimal ventricular function in some patients, exercise capacity was normal in most patients with only 20% having a diminished VO2max.…”

Do not underestimate the impact of load and of remodelling capabilities of the right heart

“…Atrial septal defects (ASDs) are one of the most common adult congenital heart diseases 1. Independently, severe functional tricuspid regurgitation (TR) alone is a poor prognosticator independent of the degree of pulmonary arterial hypertension and left ventricular systolic function 2.…”