Baseline Invasive Hemodynamics Identify Patients at Risk for Suboptimal Clinical Response After Percutaneous Atrial Septal Defect Closure.

BACKGROUND

Clinical responses after transcatheter atrial septal defect (ASD) closure are heterogeneous, and predictors of suboptimal response remain poorly defined.

AIMS: We aimed to determine whether pre-closure invasive hemodynamic parameters might predict clinical response after ASD closure.

METHODS

We retrospectively screened 223 consecutive patients undergoing percutaneous secundum ASD closure. After exclusion of 19 patients aged < 18 years, 204 adult patients were included. Clinical response was categorized as improved (n = 66), unchanged (n = 109), or suboptimal (n = 29; defined as persistent or newly apparent dyspnea and/or new initiation of diuretic therapy). Invasive hemodynamic parameters, including pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR), were assessed before closure.

RESULTS

Patients with suboptimal clinical response accounted for 14.2% of the adult cohort and had higher baseline mPAP and PCWP than those with improved or unchanged response. Although PVR differed across groups, it was not independently associated with suboptimal response in the multivariable analysis. In the multivariable model, age (OR, 1.05 per year; 95% CI, 1.00-1.09; p = 0.032) and mPAP (OR, 1.10 per mmHg; 95% CI, 1.01-1.20; p = 0.025) were independently associated with suboptimal clinical response, whereas PCWP showed a borderline association. ROC analysis demonstrated moderate discriminative ability of mPAP (AUC, 0.794; 95% CI, 0.698-0.889; p < 0.001).

CONCLUSIONS

Baseline invasive hemodynamic burden, particularly mPAP, was associated with suboptimal clinical response and may help identify patients at elevated risk after percutaneous ASD closure.