Left ventricular adaptation after atrial septal defect closure assessed by increased concentrations of N-terminal pro-brain natriuretic peptide and cardiac magnetic resonance imaging in adult patients

Abstract

Objective: To determine in an observational study whether N-terminal pro-brain natriuretic peptide (NTproBNP) is raised in patients with an atrial septal defect (ASD) and whether concentrations change after interventional closure. Methods: 12 patients (6 men, mean (SD) age 44.4 (18.6) years) with a moderate sized ASD type II (23.3 (4.5) mm, pulmonary to systemic flow ratio 2.1 (0.68)) were investigated. In all patients a magnetic resonance imaging (MRI) study was performed and NT-proBNP was assessed at baseline and early (9 (13) days) and late (138 (64) days) after intervention. Results: Concentrations of NT-proBNP were found to be within the normal range at baseline (median 87 pg/ml, interquartile range 65-181 pg/ml) but increased early after the interventional closure (315 pg/ml, 133-384 pg/ml, p = 0.005 versus baseline). The increase of NT-proBNP was associated with an increase in left ventricular dimensions as assessed by MRI (left ventricular end diastolic volume 104 (27) ml to 118 (27) ml, p = 0.003). Late after ASD closure NT-proBNP returned to baseline concentrations (102 pg/ml, 82-188 pg/ml, p = 0.004 versus early follow up). Conclusion: These findings suggest the presence of transitory haemodynamic stress during adaptation of the left ventricle after ASD closure, which may contribute to the understanding of the pathological mechanism of acute heart failure and delayed improvement of exercise capacity after ASD closure.

Hemodynamic improvement is faster after percutaneous ASD closure than after surgery

“…In patients treated percutaneously, proBNP levels had normalized by 6-month follow-up. This is in concordance with an earlier finding [41,42]. After surgery, however, proBNP levels remained higher than in controls for up to 1 year.…”

“…This may be due to increased volume to the LV after cessation of shunting through the ASD or, again, to the influence of cardiopulmonary bypass [38][39][40][41]. In patients treated percutaneously, proBNP levels had normalized by 6-month follow-up.…”

Impact of transcatheter closure of atrial septal defects on cardiac function

“…However, the shunt ratio in the current study was about 50%, which could lead to a different conclusion. Several studies reported that LV end-diastolic volume on MRI and LVDd on two-dimensional echocardiography increased during the early follow-up phase, as observed in the current study [16,17]. Although the precise mechanism of the rapid LV volume change was unclear, a sudden relief of right ventricular volume overload after ASD closure decreasing the RV dimension may improve LV oppression and LV deformity [15,17].…”

154 Aortic pulse wave velocity assessed with velocity-encoded MRI: a validation and reproducibility study

“…This is similar to a recent study which looked at left ventricular dimensions with CMR post-ASD closure [45]. In addition, they found NT-proBNP concentrations were within the normal range pre-ASD closure, but increased early after interventional closure and was associated with the increase in left ventricular dimensions as assessed by CMR [45].…”