Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect

What is it about?

Objec ve: To iden fy echocardiographic factors that correlate with pulmonary hyper- tension (PH) in adults with os um secundum atrial septal defect (ASD). Methods: Between November 2009 and November 2013, 92 adults with ASD were studied. All had clinical history and transthoracic echocardiogram. Results: Thirty-nine percent of pa ents had severe PH de ned as systolic pulmonary artery pressure (sPAP) of 70 mm Hg or more. The size of ASD (31.84±8.21 mm) and a right-sided tricuspid in ow E-wave to ssue Doppler e′-wave ra o >6.2 correlated with severe PH with AUC of 0.704 (CI 95%=0.59 to 0.818, P<.001) and 0.65 (CI 95%=0.531 to 0.773, P<.014), respec vely. Mul variate logis c regression showed that sPAP >70 mm Hg was the variable that most precisely correlated with right ven- tricular (RV) dysfunc on as evidenced by TAPSE <17 mm and RV frac onal shortening area (RVFSA) <35%. Le ventricular (LV) diastolic func on was also signi cantly re- duced in the group with severe PH with mitral in ow E/A ra o of 0.73±0.23 vs 1.13±0.42 in the group without severe PH (sPAP <70 mm Hg, (P=.001). The pulmo- nary (Qp) to systemic (Qs) cardiac output ra o (3.09±1.12) and right-sided ssue Doppler S <9.5 cm/s most accurately predicted a Tei index >0.55. Conclusions: Larger size of ASD using the QP/QS ra o and increased right-sided tricuspid E/e’ ra o correlated with severe PH with a sPAP of 70 mm Hg or more. Pa ents with severe PH had more severe RV dysfunc on as evaluated by TAPSE and RVFSA in comparison to those with PH <70 mm Hg. LV diastolic func on was also reduced in the severe PH group.

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Why is it important?

It is very important, because we need to take decisions depending on the severty of pulmonary hypertension in patients with ASD

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