The determinants of right ventricular function in patients with atrial septal defect.
OBJECTIVE
The purpose of this study was to ascertain the determinants of right ventricular (RV) systolic and diastolic functions in patients with atrial septal defect.


METHODS
Thirty-three patients with atrial septal defect having left to right shunt were enrolled in this study. RV function parameters were assessed echocardiographically. RV systolic function was assessed using tricuspid tissue Doppler S velocity (St). With regard to RV diastolic function parameters, E/A ratio, deceleration time (DT), E/Et ratio (Et = tissue Doppler E velocity), RV isovolumetric relaxation time (RVIVRT) were assessed. RV myocardial performance index (MPI) was calculated as an index of both systolic and diastolic function. Pulmonary artery stiffness (PAS) was also calculated. After echocardiography, right and left heart catheterization was performed. Mean pulmonary artery pressure (MPAP), mean right atrial pressure (MRAP), systemic flow (Qs), pulmonary flow (Qp), systemic vascular resistance (SVR), and pulmonary vascular resistance (PVR) were obtained using the data of invasive measurements.


RESULTS
In multivariate analysis, MPAP was found to be the parameter closest related to RVIVRT (r = 0.73, p < 0.001) and E/Et (r = 0.66, p < 0.001), while PAS was found to be the parameter closest related to MPI (r = 0.53, p = 0.002). In addition, St velocity was found the only parameter related to PVR (r = -0.39) in univariate analysis. There was no relationship between QP/QS and any of the RV function parameters.


CONCLUSIONS
The pulmonary vascular bed appears to be the predictor of the RV functions in patients with atrial left to right shunts, and the amount of the shunt seems to have no direct adverse influence on the RV functions.
Gorgulu
Sevket
S
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology Department, Istanbul, Turkey. sevket5@yahoo.com
Eren
Mehmet
M
Uslu
Nevzat
N
Ozer
Orhan
O
Nurkalem
Zekeriya
Z
D000328:Adult; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology*; D006801:Humans; D008297:Male; D016278:Ventricular Function, Right