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Karunanithi Z, Andersen MJ, Mellemkjær S, Alstrup M, Waziri F, Clemmensen TS, Hjortdal VE, Poulsen SH. Impaired left and right systolic ventricular capacity in corrected atrial septal defect patients. Int J Cardiovasc Imaging 2022; 38:1221-1231. [PMID: 35129735 PMCID: PMC11142960 DOI: 10.1007/s10554-021-02506-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/24/2021] [Indexed: 12/01/2022]
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.
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Affiliation(s)
- Zarmiga Karunanithi
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Mads Jønsson Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Søren Mellemkjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mathias Alstrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Farhad Waziri
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Tor Skibsted Clemmensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Wang X, Mu C, Zhang W, Xue C, Yong X, Chen K, Li D. Cardiopulmonary haemodynamics after sieve-shaped atrial septal defect repair: a multicenter study. Am J Transl Res 2021; 13:13394-13405. [PMID: 35035683 PMCID: PMC8748155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The study aimed to collect case data on cardiopulmonary bypass (CPB) sieve-shaped (S-S) and non-sieve-shaped (N-S-S) atrial septal defects (ASDs). METHODS We analysed and summarized the postoperative blood flow in the cardiopulmonary system. We retrospectively collected 86 patients who underwent CPB S-S and N-S-S ASD repair. The data collected included sex, age, CPB time, ASD area, percentage change in ventricular value (PVV) (preoperative/postoperative), left ventricular wall thickness, ejection fraction (EF) (preoperative/postoperative), fluid inflow value, pulmonary arterial pressure/pulmonary venous pressure, percentage change in total lung resistance (PTLR) (preoperative/postoperative) for statistical analysis and comparison. RESULTS There were 86 eligible patients in this study, 37 and 49 of whom had S-S and N-S-S ASDs, respectively. The PVV, PTLR, and pulmonary arterial pressure/pulmonary venous pressure (postoperative) were significantly different between the S-S and N-S-S groups. The mean PTLR in the S-S and N-S-S groups was 0.78±0.24 and 0.62±0.28, respectively. The mean PVV in the S-S group was 11.53±7.63, and that in the N-S-S group was 16.47±9.71. Multivariate analysis revealed PVV (OR, 0.143; 95% CI, 0.026-0.790; P=0.026), PTLR (OR, 0.156; 95% CI, 0.049-0.500; P=0.002), and pulmonary arterial pressure/pulmonary venous pressure (postoperative) (OR, 9.014; 95% CI, 2.480-32.755; P=0.001) as significant factors. The rate of pulmonary infection absence postoperatively in the S-S group was 76.52%, and that in the N-S-S group was 42.75%. CONCLUSION Due to the differences in heart structure between the S-S and N-S-S groups, the haemodynamic index (PVV and PTLR, postoperative pulmonary arterial pressure/pulmonary venous pressure) changes after S-S ASD repair were less than those after N-S-S ASD repair, so the postoperative pulmonary infection rate was higher after N-S-S ASD repair. The pulmonary infection rate was low after S-S ASD repair, and drugs should be reasonably administered to prevent infection.
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Affiliation(s)
- Xianzhi Wang
- Department of Thoracic and Cardiac Surgery, First People’s Hospital of GuangyuanGuangyuan 628000, Sichuan Province, China
| | - Cunfu Mu
- Department of Thoracic and Cardiac Surgery, First People’s Hospital of GuangyuanGuangyuan 628000, Sichuan Province, China
| | - Wenlin Zhang
- Department of Thoracic and Cardiac Surgery, First People’s Hospital of GuangyuanGuangyuan 628000, Sichuan Province, China
| | - Chunzhu Xue
- Department of Thoracic and Cardiac Surgery, First People’s Hospital of GuangyuanGuangyuan 628000, Sichuan Province, China
| | - Xi Yong
- Department of Vascular Surgery, North Sichuan Medical CollegeNanchong 637100, Sichuan Province, China
| | - Kai Chen
- Department of Vascular Surgery, North Sichuan Medical CollegeNanchong 637100, Sichuan Province, China
| | - Dianyuan Li
- Department of Cardiovascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical UniversitySuzhou 215000, Jiangsu, China
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Araujo JJ. Stress Echocardiography in Pediatric and Adult Congenital Heart Disease: A Complement in Anatomical and Functional Assessment. Curr Probl Cardiol 2020; 46:100762. [PMID: 33373837 DOI: 10.1016/j.cpcardiol.2020.100762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Functional classification of children and adults with repaired and unrepaired congenital heart disease is a challenge for clinicians, due to the heterogeneity of congenital heart disease. Functional studies may be complemented with a stress echocardiogram, which analyzes the hemodynamic behavior of surgical repair zones, residuals, and sequelae. The integration of the anatomical and functional classification criteria developed for congenital heart disease and the results of a stress echocardiogram can establish a more precise functional classification. Stress echocardiograms also provide early diagnosis of functional complications of the congenital heart, allowing timely management decisions. This paper reviews the most important aspects of stress echocardiograms in pediatric and adult congenital heart disease, seeking to spark cardiologists' interest in extending its applications in congenital heart disease.
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Affiliation(s)
- John Jairo Araujo
- Cochair Adult Congenital Heart Disease Council in Inter American Society of Cardiology, Departament Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center Rionegro, Colombia, Cardiologist Echocardilogist in Pediatric and Adult Congenital Heart Disease.
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Amedro P, Guillaumont S, Bredy C, Matecki S, Gavotto A. Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up. J Thorac Dis 2018; 10:S2864-S2873. [PMID: 30305946 DOI: 10.21037/jtd.2017.11.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nearly four decades ago, the World Health Organization stated that functional capacity explorations best reflected the impact of a chronic disease on quality of life. Today, cardio-pulmonary exercise test (CPET) is recommended in the follow-up of patients with congenital heart diseases (CHDs). Indeed, the maximum oxygen uptake (VO2max) and the ventilatory efficiency (VE/VCO2 slope) correlate with both the prognosis and the quality of life in this population. Atrial septal defects (ASDs) represent the second most frequent CHD and are usually considered as simple CHDs. However, the exercise capacity of ASD patients may be impaired. Therefore, the CPET provides important information in assessment and follow-up of patients with ASDs, for both children and adults. Exercise capacity of patients with unrepaired ASDs depends on the importance of the shunt, the right ventricular (RV) function and volume overload, the level of pulmonary arterial pressure, and the occurrence of arrhythmias. For repaired ASDs, exercise capacity also depends on the delay before closure and the type of procedure (catheter or surgery). In most cases, the exercise capacity is nearly normal and CPET contributes to promote sports participation. In addition, a regular CPET follow-up is necessary to evaluate the occurrence, severity and physiological mechanisms of comorbidities, i.e., heart failure, pulmonary hypertension and arrhythmia. Furthermore, CPET follow-up in patients with ASDs may detect early onset of muscular deconditioning, for which cardiac rehabilitation may be considered.
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Affiliation(s)
- Pascal Amedro
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Charlene Bredy
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Stefan Matecki
- Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Arthur Gavotto
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017; 30:101-138. [DOI: 10.1016/j.echo.2016.10.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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6
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1191-1229. [DOI: 10.1093/ehjci/jew190] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022] Open
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Wyss Y, Quandt D, Weber R, Stiasny B, Weber B, Knirsch W, Kretschmar O. Interventional Closure of Secundum Type Atrial Septal Defects in Infants Less Than 10 Kilograms: Indications and Procedural Outcome. J Interv Cardiol 2016; 29:646-653. [DOI: 10.1111/joic.12328] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yves Wyss
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
| | - Daniel Quandt
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Roland Weber
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Brian Stiasny
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Benedikt Weber
- Clinic for Cardiovascular Surgery; University Hospital of Zurich; Zurich Switzerland
| | - Walter Knirsch
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Oliver Kretschmar
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
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8
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Nassif M, Heuschen CBBC, Lu H, Bouma BJ, van Steenwijk RP, Sterk PJ, Mulder BJM, de Winter RJ. Relationship between atrial septal defects and asthma-like dyspnoea: the impact of transcatheter closure. Neth Heart J 2016; 24:640-646. [PMID: 27561281 PMCID: PMC5065534 DOI: 10.1007/s12471-016-0879-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with atrial septal defects (ASD) are often misdiagnosed as asthma patients and accordingly receive erroneous bronchodilator treatment. In order to characterise their symptoms of dyspnoea to explain this clinical observation, we investigated the prevalence of asthma-like symptoms in patients with secundum ASD who then underwent successful percutaneous closure. METHODS A total of 80 ASD patients (74 % female, mean age 46.7 ± 16.8 years, median follow-up 3.0 [2.0-5.0] years) retrospectively completed dyspnoea questionnaires determining the presence and extent of cough, wheezing, chest tightness, effort dyspnoea and bronchodilator use on a 7-point scale (0 = none, 6 = maximum) before and after ASD closure. The Mini Asthma Quality of Life (Mini-AQLQ) and Asthma Control Questionnaire with bronchodilator use (ACQ6) were administered. RESULTS A total of 48 (60 %) patients reported cough, 27 (34 %) wheezing, 26 (33 %) chest tightness and 62 (78 %) effort dyspnoea. Symptom resolution or reduction was found in 64 (80 %) patients after ASD closure. Asthma symptom scores decreased significantly on the Mini-AQLQ and ACQ6 (both p < 0.001). The number of patients using bronchodilators decreased from 16 (20 %) to 8 (10 %) patients after ASD closure (p = 0.039) with less frequent use of bronchodilators (p = 0.015). CONCLUSIONS A high prevalence of asthma-like symptoms and bronchodilator use is present in ASD patients, which exceeds the low prevalence of bronchial asthma in this study population. Future prospective research is required to confirm this phenomenon. The presence of an ASD should be considered in the differential diagnosis of patients with asthma-like symptoms, after which significant symptom relief can be achieved by ASD closure.
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Affiliation(s)
- M Nassif
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - C B B C Heuschen
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - H Lu
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - B J Bouma
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - R P van Steenwijk
- Department of Pulmonary Medicine, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - P J Sterk
- Department of Pulmonary Medicine, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - R J de Winter
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
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Park HK, Shin HJ, Park YH, Ma BG. The importance of preoperative oxygen saturation as a predictor of pulmonary arterial hypertension after surgery of atrial septal defects. Interact Cardiovasc Thorac Surg 2016; 23:424-30. [PMID: 27222001 DOI: 10.1093/icvts/ivw162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/26/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES There is no concrete predictor of the change of pulmonary arterial pressure after surgical closure of an atrial septal defect (ASD) in patients with pulmonary arterial hypertension (PAH). The aim of this study was to investigate the role of preoperative room air arterial oxygen saturation (SaO2) (arterial blood gas data) as a predictor of postoperative PAH. METHODS The medical records of 36 patients [>20 years, mean pulmonary arterial pressure (mPAP) ≥25 mmHg] who underwent surgical closure of an ASD between March 2004 and January 2014 were retrospectively reviewed. RESULTS The median age was 47 years (range, 24.6-65.9 years) and mPAP was 38 ± 14 mmHg. The mean pulmonary vascular resistance (Rp) was 3.9 ± 4.2 Wood units, and fenestration was performed in 12 (33%) patients. Only 1 patient received anti-PAH medication preoperatively. The median follow-up period was 4 years (range, 0-10 years). There were two hospital deaths, one of which was related to PAH. At the last follow-up, PAH (estimated tricuspid regurgitation velocity >3 m/s) existed in 7 patients (19%), and 10 patients (28%) were receiving anti-PAH medications (considered as clinical PAH). Univariate analysis for persistent clinical PAH revealed that mPAP, Qp/Qs, Rp, room air arterial oxygen saturation and postoperative functional class were significant risk factors. Only SaO2 remained a significant risk factor in multivariate analysis (P = 0.03). CONCLUSIONS Preoperative room air SaO2 is a useful predictor of persistent PAH in adult patients undergoing surgical closure of an ASD.
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Affiliation(s)
- Han Ki Park
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Hong Ju Shin
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Young Hwan Park
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Bo Gyoung Ma
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
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Blok IM, van Riel ACMJ, Schuuring MJ, Duffels MG, Vis JC, van Dijk APJ, Hoendermis ES, Mulder BJM, Bouma BJ. Decrease in quality of life predicts mortality in adult patients with pulmonary arterial hypertension due to congenital heart disease. Neth Heart J 2015; 23:278-84. [PMID: 25911012 PMCID: PMC4409603 DOI: 10.1007/s12471-015-0666-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Decrease in quality of life (QoL) in left-sided heart failure precedes poor survival, which can be reversed with exercise training. We investigated whether QoL is associated with mortality in pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) patients. Methods In this observational study, PAH-CHD adults referred for PAH-specific therapy were included. QoL surveys (SF36) were recorded during 2 years of therapy. Based on shift in SF36 scores during this period, patients had either decreased or non-decreased QoL. Subsequently, the patients were followed for mortality. Results Thirty-nine PAH-CHD patients (mean age 42, 44 % male, 49 % Down’s syndrome) were analysed. Following PAH-specific therapy, SF36 physical component summary (PCS) decreased in 13 (35–31 points, p = 0.001) and showed no decrease in 26 patients (34–43 points, mean values, p < 0.001). Post-initiation phase, median follow-up was 4.5 years, during which 12 deaths occurred (31 %), 10 (56 %) in the decreased and 2 (10 %) in the non-decreased group (p = 0.002). Cox regression showed a decrease in SF36 PCS predicted mortality (HR 3.4, 95 % CI 1.03–11, p = 0.045). Conclusions In PAH-CHD patients, decrease in SF36 PCS following initiation of PAH-specific therapy is a determinant of mortality. Electronic supplementary material The online version of this article (doi:10.1007/s12471-015-0666-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I M Blok
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Abstract
Secundum atrial septal defect (ASDII) is a common congenital heart defect that causes shunting of blood between the systemic and pulmonary circulations. Patients with an isolated ASDII often remain asymptomatic during childhood and adolescence. If the defect remains untreated, however, the rates of exercise intolerance, supraventricular arrhythmias, right ventricular dysfunction and pulmonary arterial hypertension (PAH) increase with patient age, and life expectancy is reduced. Transcatheter and surgical techniques both provide valid options for ASDII closure, the former being the preferred method. With the exception of those with severe and irreversible PAH, closure is beneficial to, and thus indicated in all patients with significant shunts, regardless of age and symptoms. The symptomatic and survival benefits conferred by defect closure are inversely related to patient age and the presence of PAH, supporting timely closure after diagnosis. In this paper we review the management of adult patients with an isolated ASDII, with a focus on aspects of importance to the decision regarding defect closure and medical follow-up.
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Gabriels C, Lancellotti P, Van De Bruaene A, Voilliot D, De Meester P, Buys R, Delcroix M, Budts W. Clinical significance of dynamic pulmonary vascular resistance in two populations at risk of pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging 2014; 16:564-70. [DOI: 10.1093/ehjci/jeu287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/17/2014] [Indexed: 11/12/2022] Open
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13
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Gabriels C, De Meester P, Pasquet A, De Backer J, Paelinck BP, Morissens M, Van De Bruaene A, Delcroix M, Budts W. A different view on predictors of pulmonary hypertension in secundum atrial septal defect. Int J Cardiol 2014; 176:833-40. [DOI: 10.1016/j.ijcard.2014.08.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/25/2014] [Accepted: 08/02/2014] [Indexed: 12/21/2022]
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Affiliation(s)
- M C Post
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands,
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Preeshagul I, Gharbaran R, Jeong KH, Abdel-Razek A, Lee LY, Elman E, Suh KS. Potential biomarkers for predicting outcomes in CABG cardiothoracic surgeries. J Cardiothorac Surg 2013; 8:176. [PMID: 23866777 PMCID: PMC3726492 DOI: 10.1186/1749-8090-8-176] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 06/06/2013] [Indexed: 11/10/2022] Open
Abstract
The variations in recovery time, complications, and survival among cardiac patients who have undergone coronary artery bypass graft (CABG) procedures are vast. Many formulas and theories are used to predict clinical outcome and recovery time, and current prognostic predictions are based on medical and family history, lifestyle, co-morbidities, and performance status. The identification of biomarkers that provide concrete evidence supporting clinical outcome has greatly affected the field of medicine, helping clinicians in many medicine sub-specialties to forecast clinical course. Recent studies have discovered biomarkers that may be used as predictors of cardiac patients' status post-cardiothoracic surgery, and the applications are numerous. In this review, we assess currently available cardiac biomarkers as predictors of clinical outcome for post-operative CABG patients. Data were collected from various studies in which cardiac biomarkers were measured in pre-operative and post-operative CABG patients.
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Affiliation(s)
- Isabel Preeshagul
- The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ 07601, USA
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