Temporal profile of right and left ventricular wall deformation analysis using 2D speckle tracking echocardiography following atrial septal defect closure.

BACKGROUND

Analysing temporal strain changes in right ventricular (RV) and left ventricular (LV) walls post-atrial septal defect (ASD) closure is of clinical importance.

AIMS: We aimed to evaluate acute/short-term changes in RV/LV wall deformation after ASD closure using two-dimensional speckle tracking echocardiography (2D-STE).

METHODS

A total of 43 patients with ASD and 20 controls had echocardiograms before and after ASD closure.

RESULTS

Of the 43 patients with 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; 2-chamber view GLS: 16.95% vs 20.73%; p=0.0001, apical long-axis view GLS 16.48% vs 20.90%; p=0.0001, 4-chamber view GLS 16.93% vs 21.56%; p=0.0001, average GLS 16.75% vs 21.31%; p=0.0001) and RV GLS (19.22% vs 24.27%; p=0.0001) were significantly lower in the patients with ASD compared to controls. After closure, the average LV GLS rapidly improved at 24 hours from baseline (16.75% to 17.28%; p=0.004), with sustained increases at 1 and 3 months (18.16% and 19.40%; p=0.001). The mean RV GLS also improved at all serial timepoints (baseline, 24 hrs, 1 month, and 3 months) with values of 19.22%, 19.85%, 20.70%, and 22.23%, respectively (p=0.0001). As compared to surgery, LV GLS and RV GLS were much better in the device group (average LV GLS at 24 hrs, 1 month, and 3 months: 16.54% vs 17.98%, 17.34% vs 18.92%, and 18.80% vs 19.96%, respectively; mean RV GLS at 24 hrs, 1, and 3 months: 17.83% vs 21.78%, 18.73% vs 22.58%, and 20.70% vs 23.70%, respectively).

CONCLUSIONS

This GLS study demonstrates significant reverse remodelling of both the RV and LV after ASD closure. Device closure was associated with superior strain rate recovery compared to surgery at the 3-month midterm follow-up.