Strain Analysis during Exercise in Patients with Asymptomatic Atrial Septal Defect

Abstract

Corrections added on 13th May 2014, after first online publication: authors affiliation were changed] Background: Right ventricular (RV) deformational mechanics have been demonstrated in patients with atrial septal defect (ASD) at rest, but there is lack of information on their adaptation to exercise. The aim of this study was to assess the adaptability of RV strains and strain rates (SRs) during exercise in patients with clinically asymptomatic ASD. Methods: Twenty patients with asymptomatic ASD and 11 agematched controls were included. All the subjects performed incremental ergometry and underwent standard echocardiography and two-dimensional strain (S) and SR imaging by speckle tracking at rest and during submaximal exercise. Results: There was no significant difference in RV strains and SRs at rest between the controls and the ASD patients. There was a significant elevation in the strains and SRs of both groups with exercise. However, the lateral and septal strains increased significantly higher than the controls in patients with ASD. But there was no significant difference in SRs during exercise in both of the groups. Conclusions: Asymptomatic ASD patients without RV overload, have same strain and SR results at rest with the controls, however, these findings worsen during submaximal exercise, when compared to the controls. (Echocardiography 2014;31:1239-1244

Three‐Dimensional Echocardiography in the Evaluation of Right Ventricular Global and Regional Systolic Function in Patients with Atrial Septal Defect before and after Percutaneous Closure

“…3,27 Impaired RV contraction has been detected in patients with ASD by radionuclide and speckle tracking studies. 5,28 Our data were in accordance with a recent RT3DE study by Ding et al, 23 which reported decreased of RV ejection fraction and increased myocardial performance index in ASD, indicating the impairment of RV function. Similar results were demonstrated in a cardiovascular magnetic resonance study which reported decreased RV ejection fraction in open ASD.…”

“…Although the right ventricle tolerates volume loading better than the left ventricle, long standing volume overload is detrimental and can cause pressure overload, leading to RV dysfunction . Impaired RV contraction has been detected in patients with ASD by radionuclide and speckle tracking studies . Our data were in accordance with a recent RT3DE study by Ding et al., which reported decreased of RV ejection fraction and increased myocardial performance index in ASD, indicating the impairment of RV function.…”

“…Right ventricular (RV) dysfunction is closely related to patient outcome in open and closed ASD . Two‐dimensional echocardiography has been widely used in the assessment of RV systolic function in ASD . However, there are certain limitations in two‐dimensional methods considering the complicated anatomy and irregular chamber shape of the right ventricle .…”

“…2,3 Two-dimensional echocardiography has been widely used in the assessment of RV systolic function in ASD. [4][5][6][7][8][9][10][11][12] However, there are certain limitations in two-dimensional methods considering the complicated anatomy and irregular chamber shape of the right ventricle. 13,14 Real time threedimensional echocardiography (RT3DE) is a recently introduced echocardiographic technique with the advantage of displaying the three-dimensional structure of the heart.…”

Utility of Isovolumic Contraction Peak Velocity for Evaluation of Adult Patient Status after Transcatheter Closure of Atrial Septal Defect

“…Exercise tolerance tests, such as cardiopulmonary exercise tests, were not part of this study. As an increase in oxygen consumption after ASD closure and the utility of strain analysis during exercise in asymptomatic patients were reported previously, exercise tolerance tests may well be useful for more precise symptomatic evaluation. Furthermore, the assessment of isovolumic contraction acceleration was not part of this study due to its poor reproducibility.…”