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Clinical significance of right ventricular-pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect

Authors
 Seon Hwa Lee  ;  Yu Rim Shin  ;  Dae-Young Kim  ;  Jiwon Seo  ;  Iksung Cho  ;  Sak Lee  ;  Jung Sun Kim  ;  Geu-Ru Hong  ;  Jong-Won Ha  ;  Chi Young Shim 
Citation
 FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol.9 : 896711, 2022-11 
Journal Title
FRONTIERS IN CARDIOVASCULAR MEDICINE
Issue Date
2022-11
Keywords
atrial septal defect ; echocardiography ; old age ; right ventricular-pulmonary artery coupling ; tricuspid regurgitation (TR)
Abstract
Background: Functional tricuspid regurgitation (TR) usually decreases after atrial septal defect (ASD) closure; however, it may persist and cause heart failure that requires treatment. We aimed to investigate clinical and echocardiographic factors predicting persistent TR after ASD closure.

Methods: Among 348 adults who underwent isolated ASD closure between January 2010 and September 2020, 91 (26.1%) patients with significant TR (at least moderate degree) before ASD closure were included. Persistent TR was defined as significant TR on echocardiography at 6 months to 1 year after ASD correction. We comprehensively analyzed the echocardiogram before ASD closure, including speckle-tracking imaging. Right ventricular (RV)-pulmonary arterial (PA) (RV-PA) coupling was assessed by the ratio of RV global longitudinal strain (RV GLS) and tricuspid annular S' velocity to PA systolic pressure (PASP).

Results: Persistent TR was observed in 22 (24.2%) patients. Patients with persistent TR were significantly older and had larger TR jet areas and lower RV-PA coupling parameters than those without persistent TR. On multivariable regression, persistent TR was independently associated with age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.14, p = 0.030) and
RV GLS
/PASP (OR 0.001, 95% CI 0.00-0.017, p = 0.012). ROC curves analysis showed that
RV GLS
/PASP's best cut-off for persistent TR was 0.46 (cut-off 0.46, the area under the curve 0.789, p < 0.001).

Conclusion: Persistent TR after ASD closure is not rare. Old age and RV-PA uncoupling could be associated with persistent TR after ASD closure. In older patients with abnormal RV-PA coupling, careful evaluation and concomitant or subsequent TR intervention may be considered.
Files in This Item:
T202205860.pdf Download
DOI
10.3389/fcvm.2022.896711
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Seo, Jiwon(서지원) ORCID logo https://orcid.org/0000-0002-7641-3739
Shin, Yu Rim(신유림)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seonhwa(이선화)
Cho, Ik Sung(조익성)
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/192820
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