Hemodynamic changes during transcatheter atrial septal defect closure predict midterm heart failure deterioration in adults

Catheter Cardiovasc Interv. 2021 Nov 1;98(5):E715-E723. doi: 10.1002/ccd.29859. Epub 2021 Jul 6.

Abstract

Objectives: To investigate whether hemodynamic changes during balloon occlusion test (BOT) predict future heart failure (HF) deterioration after transcatheter atrial septal defect closure (tASD-closure).

Background: Midterm HF deterioration can sometimes occur after tASD-closure in adults. Whether hemodynamic changes during tASD-closure can help identify patients at risk is unknown.

Methods: This prospective observational study enrolled 86 consecutive adult patients who underwent tASD-closure. Hemodynamic parameters, including pulmonary capillary wedge pressure (PCWP), were measured at baseline, during BOT, and after tASD-closure. The changes in PCWP during BOT and after tASD-closure were defined as ΔPCWP (Occ-Pre) and ΔPCWP (Post-Pre), respectively. Clinical parameters were evaluated before tASD-closure and during the 3-month follow-up. We assessed the occurrence of HF deterioration (HF requiring hospitalization or additional diuretics) during a 2-year follow-up period and categorized patients into HF (+) and HF (-) groups accordingly. The aforementioned parameters were compared between groups.

Results: Midterm HF deterioration occurred in 12 patients (13.9%). Compared to the HF (-) group, the HF (+) group presented a significantly higher ΔPCWP (Occ-Pre) (9.5 ± 4.4 mmHg vs. 3.0 ± 3.3 mmHg; p < 0.001) and ΔPCWP (Post-Pre) (4.0 ± 2.8 mmHg vs. 0.6 ± 1.8 mmHg; p = 0.004). Receiver operating characteristic curve analysis showed that the ΔPCWP (Occ-Pre) cutoff value of 5.5 mmHg had excellent ability to predict HF deterioration (Area under the curve 0.886 [0.779-0.993], p < 0.001; sensitivity 0.917, specificity 0.824).

Conclusions: Increases in PCWP during BOT predict midterm HF deterioration after tASD-closure. Close surveillance may be needed in patients with a ΔPCWP (Occ-Pre) >5 mmHg.

Keywords: balloon occlusion test; congenital heart defects; pulmonary wedge pressure; risk assessment; transcatheter atrial septal defect closure.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Cardiac Catheterization / adverse effects
  • Heart Failure* / diagnosis
  • Heart Failure* / etiology
  • Heart Failure* / therapy
  • Heart Septal Defects, Atrial* / diagnostic imaging
  • Heart Septal Defects, Atrial* / therapy
  • Hemodynamics
  • Humans
  • Treatment Outcome