Abstract 1777: Assessment of Right Ventricular Function by Three-dimensional and Myocardial Imaging Echocardiography After Percutaneous Atrial Septal Defect Closure in Adults
Purpose. Real-time three-dimensional (3D) echocardiography allows us to measure right ventricular (RV) end-diastolic volume (EDV) irrespective of its shape. Tissue Doppler imaging (TDI) and speckle tracking imaging (STI) are new tools to assess myocardial function. We sought to evaluate RV function by 3D and myocardial imaging echocardiography in adult patients with atrial septal defect (ASD) before and six months after transcatheter closure.
Methods. Seventeen ASD patients were studied using a system equipped with a real-time X3 transducer (Vivid 9 ultrasound system, GE, Horten, Norway). Standard parameters of RV function (fractional area change, tricuspid annular plane systolic excursion -TAPSE-, Tei index) were calculated. RV peak systolic velocities, peak systolic strain, and peak systolic and diastolic strain-rate were obtained in the basal, mid and apical segments in apical 4-chamber view by TDI and STI (EchoPAC BT09, GE Ultrasound). 15 healthy age- and sex-matched adults were selected as a control group.
Results. RV ejection fraction (3D-RVEF) was significantly larger compared to controls and decreased significantly after closure (0.59±0.05 vs 0.47±0.09, p<.01). 3D-EDV showed better correlations than 2D-EDV with RV function parameters. TAPSE decreased significantly (22.4±8.3 vs. 17.9±5.7mm, p<.05). Higher RV basal-mid-segment peak systolic velocities were recorded, which returned to normal values after the procedure. Global RV longitudinal strain was significantly higher than control group and had significant reduction after defect closure (−24.4±5.1 vs. −20.7±4.3%, p<.05). Strain was reduced especially in RV mid and apical lateral segments (mid strain: −28.3±7.2 vs −23.8±4.6%, p<.01; apical strain −26.4±6.4 vs −20.1±4.3% vs., p<.001) with good correlation with 3D-RVEF (r=−0.79, p<.001). There was no significant change in the global RV strain-rate. By multivariate analysis, apical strain (p=0.006) and TAPSE (p=0.04) were predictive of a decreased 3D-RVEF.
Conclusions. 3D and myocardial imaging echocardiography appear to be helpful for a quantitative assessment of RV function after ASD closure. Velocity parameters are the most dependent and strain-rate values the less dependent on RV volume overload.