title: Regional right ventricular deformation in patients with open and closed atrial septal defect.
abstract: OBJECTIVE
  This study aimed at (i) evaluating regional right ventricular (RV) deformation in patients with an atrial septal defect (ASD)-type secundum using strain and strain rate imaging and (ii) investigating the relation of regional deformation with functional capacity using cardiopulmonary exercise testing (CPET) in order to identify subclinical changes in RV function.
  
  
  RESULTS
  Forty-five patients with ASD-type secundum (18 open, 27 closed) and 20 age-matched controls were included. All underwent standard echocardiography and colour-Doppler myocardial velocity imaging. Longitudinal deformation was measured in the RV free wall divided in two segments. ASD patients underwent symptom-limited CPET. When compared with controls, apical strain was higher (-38.2 ± 9.9 vs. -29.9 ± 6.6%; P= 0.004) and lower (-25.2 ± 6.1 vs. -29.9 ± 6.6%; P= 0.006) in patients with an open and a closed ASD, respectively. Apical strain was higher (-38.2 ± 9.9 vs. -27.9 ± 6.6%; P= 0.001) and lower (-25.2 ± 6.1 vs. -28.7 ± 7.4%; P= 0.022) than basal strain in patients with an open and a closed ASD, respectively. In patients with an open ASD, apical strain correlated with shunt-ratio (R = -0.78; P< 0.0001), RV end-diastolic area (R = -0.68; P= 0.002), and RV stroke volume (R = -0.67; P= 0.002). Peak oxygen consumption (peak vO₂) was below average in patients with an open (79 ± 19% predicted; P< 0.0001) and a closed ASD (89 ± 18% predicted; P= 0.002). After ASD repair, apical strain correlated with peak vO₂ (R = -0.49; P= 0.01) and with ventilatory efficiency (R = 0.62; P= 0.001).
  
  
  CONCLUSIONS
  Volume overload of the right ventricle in patients with ASD-type secundum causes a regional deformation pattern with higher apical strain, related to parameters of volume load severity. After ASD repair, lower apical strain values correlated with functional capacity. Measurement of apical strain seems sensitive for detecting mild RV dysfunction.
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Van De Bruaene
authors.forename: Roselien
authors.initials: R
authors.lastname: Buys
authors.forename: Luc
authors.initials: L
authors.lastname: Vanhees
authors.forename: Marion
authors.initials: M
authors.lastname: Delcroix
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000379:methods; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods; D018618:Echocardiography, Doppler, Color / Q000379:methods; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012016:Reference Values; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D055815:Young Adult