Abstract 15174: Predictors of Lack of Right Atrial Reverse Remodeling after Atrial Septal Defect Device Closure
Purpose: Despite the evidence for the benefits of device closure of atrial septal defect (ASD) on right atrial (RA) volume, there are still some patients with persistent RA enlargement which may be related to the subsequent development of atrial fibrillation. This prospective study evaluated the prevalence and determinants of residual atrial enlargement at mid-term after ASD closure in adults.
Methods: Echocardiography was done in 44 consecutive patients (47±17 yrs, 10 males) with secundum ASD and without history of atrial arrhythmia before and at 3 month after ASD closure. Residual RA enlargement, defined as RA volume index (RAVI) ≥21ml/m2, was measured by monoplane area-length method at the end-systole.
Results: Before closure, all patients had enlarged RA which reduced in sizes at 3 month (RAVI: 83±45 vs. 43±28 ml/m2, p<0.001). However, 25 (57%) patients exhibited residual RA enlargement. They were older, had a larger shunt, a higher pulmonary arterial pressure, more tricuspid regurgitation and larger right ventricular volume and RAVI at baseline compared to those with normalization of RA volume (Table 1). Multivariate logistic model with these covariates showed pre-closure RAVI was the only independent determinant for residual RA enlargement (odds ratio: 1.12, p=0.018). Receiver Operating Characteristic (ROC) curve revealed that a cut-off value of RAVI ≥40ml/m2 was 84% sensitive and 72% specific in predicting residual RA enlargement. Pre-closure RAVI correlated to the age at closure and the magnitude of interatrial shunting (both r=0.51, p<0.01).
Conclusion: RA volume normalized in only about half of adults at mid-term after ASD device closure and residual RA enlargement was related to an excessive pre-closure RA dilatation. This suggests ASD be closed timely in adult before irreversible structural damage to RA. Long-term follow up is warranted to explore the relation between residual RA enlargement and the risk of developing atrial arrhythmias.
- © 2010 by American Heart Association, Inc.