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

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

doi:10.3389/fcvm.2022.896711

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

Front Cardiovasc Med. 2022 Nov 14:9:896711. doi: 10.3389/fcvm.2022.896711. eCollection 2022.

Authors

Affiliations

¹ Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
² Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
³ Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.

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.

Keywords: atrial septal defect; echocardiography; old age; right ventricular-pulmonary artery coupling; tricuspid regurgitation (TR).