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

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  • Zarmiga Karunanithi
  • Mads Jønsson Andersen
  • Søren Mellemkjær
  • Mathias Alstrup
  • Farhad Waziri
  • Tor Skibsted Clemmensen
  • Hjortdal, Vibeke Elisabeth
  • Steen Hvitfeldt Poulsen

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.

OriginalsprogEngelsk
TidsskriftInternational Journal of Cardiovascular Imaging
Vol/bind38
Udgave nummer6
Sider (fra-til)1221-1231
Antal sider11
ISSN1569-5794
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
This work was funded by The Children’s Heart Foundation Denmark [Grant No. 18-R110-A5174-26044], Aarhus University, and Helga and Peter Korning’s Fond. Vibeke E. Hjortdal is funded on a grant from Novo Nordic Foundation [Grant No. NNFSA170030576] since May 2019.

Publisher Copyright:
© 2022, The Author(s).

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