Title : Predictors of treatment success among patients with atrial septal defect and pulmonary hypertension who underwent device or surgical closure
Abstract:
Introduction: ASD has a generally good prognosis and if left untreated can lead to PH. The present study was conducted to determine the predictors of treatment success among adult ASD with PH and develop a scoring system based on the identified factors. Methods: Adult patients with ASD and PH who underwent hemodynamic studies before closure and had available data on treatment outcome within hospital stay from the time of the procedure were included in the study. Multiple logistic regression analyses were performed and a scoring system was then created based on the log-odds ratios (beta coefficient). Results: 297 patients were included with 269 (90.57%) of the patients had successful ASD closure. Factors associated with treatment success were LA size >37mm [odds ratio (OR) 12.31; P =942 in dynes/seconds/cm-5 (OR 6.08 ; P = 0.002, Beta coefficient 1.81). The scoring system ranges from 0 to 6 where a score of > 3 suggests an increased likelihood of successful closure. The scoring system showed good discriminative ability, acceptable accuracy (75.09%), sensitivity ( 73.88%) and specificity ( 88%). Discussion: The proposed scoring system which includes LA size, PH severity, and SVR, can be utilized to identify ASD patients with PH in whom successful closure can be achieved.
