Title : Temporal profile of RV and LV wall deformation analysis using 2D Speckle Tracking Echocardiography (STE) following ASD closure
Abstract:
Background: It is important to analyse the temporal profile of recovery of RV & LV wall strain parameters following ASD closure.
Objectives: The aim of this study is to analyze the acute & short-term changes after atrial septal defect (ASD) closure by evaluating the RV and LV wall deformations using 2D speckle tracking echocardiography (STE).
Methods: Pre- and post-ASD closure 2D speckle tracking echocardiography (STE) of 43 patients were done.
Results: Of 43 patients of secundum ASD (mean age 27.37 years), 48.8% were closed surgically, while 51.2% underwent device closure. At baseline, LV global longitudinal strain (GLS) (GLS 2C: 16.95±3.68 vs 20.73±1.78, p=0.0001, GLS APLAX 16.48±3.31 vs 20.90±1.63, p=0.0001, GLS 4C 16.93±3.87 vs 21.56±1.33, p=0.0001, average GLS 16.75±2.35 vs 21.31±1.16, p=0.0001) and RV GLS% (19.22%±3.59 vs 24.27%±2.96, p=0.0001) was significantly lower in the patients. After closure, mean average LV GLS rapidly improved at 24 hours (16.75±2.39 to 17.28±2.46, p=0.004), with sustained increase at 1 & 3 months (18.16±2.30 and 19.40±2.05, p=0.0001). Mean RV GLS also improved at all serial time points (19.22±3.59, 19.85±3.66, 20.70±3.63 and 22.23±3.36, p=0.0001). As compared to surgery, LVGLS and RVGLS were much better in device group (average LV GLS at 24 hrs, 1 & 3 months 16.54±1.86 vs 17.98±2.78, 17.34±1.79 vs 18.92±2.49 and 18.80±1.75 vs 19.96±2.19, respectively) and RV GLS at 24 hrs, 1 & 3 months (17.83±2.37 vs 21.78±3.66, 18.73±2.29 vs 22.58±3.70 and 20.70±2.16 vs 23.70±3.67). The % of patients with LV GLS>−18% (23.80% vs 9.09%) and RV GLS>−20% at 3 months (38.09% vs 4.54%) was also higher in the surgical group. An ASD size>29 mm had a sensitivity of 84.85 and 80% and positive predictive value of 77.78 and 82.35% in predicting LV GLS>-18% and RVGLS>-20% at 3 months.
Conclusion: Assessment of biventricular function with speckle tracking echocardiography demonstrates significant reverse remodelling of both RV & LV after transcatheter & surgical closure of ASD. Device closure was associated with superior strain rate recovery as compared to surgery at mid-term follow up of 3 months.
