Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect.
OBJECTIVE
To identify echocardiographic factors that correlate with pulmonary hypertension (PH) in adults with ostium secundum atrial septal defect (ASD).


METHODS
Between November 2009 and November 2013, 92 adults with ASD were studied. All had clinical history and transthoracic echocardiogram.


RESULTS
Thirty-nine percent of patients had severe PH defined as systolic pulmonary artery pressure (sPAP) of 70 mm Hg or more. The size of ASD (31.84±8.21 mm) and a right-sided tricuspid inflow E-wave to tissue Doppler e'-wave ratio >6.2 correlated with severe PH with AUC of 0.704 (CI 95%=0.59 to 0.818, P<.001) and 0.65 (CI 95%=0.531 to 0.773, P<.014), respectively. Multivariate logistic regression showed that sPAP >70 mm Hg was the variable that most precisely correlated with right ventricular (RV) dysfunction as evidenced by TAPSE <17 mm and RV fractional shortening area (RVFSA) <35%. Left ventricular (LV) diastolic function was also significantly reduced in the group with severe PH with mitral inflow E/A ratio of 0.73±0.23 vs 1.13±0.42 in the group without severe PH (sPAP <70 mm Hg, (P=.001). The pulmonary (Qp) to systemic (Qs) cardiac output ratio (3.09±1.12) and right-sided tissue Doppler S <9.5 cm/s most accurately predicted a Tei index >0.55.


CONCLUSIONS
Larger size of ASD using the QP/QS ratio and increased right-sided tricuspid E/e' ratio correlated with severe PH with a sPAP of 70 mm Hg or more. Patients with severe PH had more severe RV dysfunction as evaluated by TAPSE and RVFSA in comparison to those with PH <70 mm Hg. LV diastolic function was also reduced in the severe PH group.
Outpatient Department, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.
Jorge
J
Cossío-Aranda
Outpatient Department, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.
Karina Del Valle
KD
Zamora
Department of Medicine, University of Alabama, Birmingham, Alabama.
Navin C
NC
Nanda
Department of Medicine, University of Alabama, Birmingham, Alabama.
Anezi
A
Uzendu
Interpreters Service, Massachusetts General Hospital, Boston, Massachusetts.
Candace
C
Keirns
National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.
Juan
J
Verdejo-Paris
National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.
Marco Antonio
MA
Martínez-Ríos
Outpatient Department, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.
Nilda
N
Espinola-Zavaleta
D000328:Adult; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology*
atrial septal defect; echocardiography; pulmonary hypertension; right ventricular function