Acute effect of transcatheter closure on right ventricular function in patients with atrial septal defect assessed by tissue Doppler imaging.

OBJECTIVE

Echocardiographic measurement of right ventricular function in patients with atrial septal defect (ASD) is challenging. The Doppler myocardial performance index (MPI) may provide a method of assessing function in these patients. The aim of this study was to evaluate right ventricular function and its changes after transcatheter closure in patients with ASD using MPI by tissue Doppler imaging (TDI).

METHODS

MPI, defined as the sum of isovolumic relaxation and isovolumic contraction time divided by ejection time, was measured by tissue Doppler imaging and pulsed Doppler (PD), respectively. Measurement of time intervals and MPI with TDI and PD were performed in 46 patients with ASD before closure, and at 3 days, 1 month after closure. Twenty-two healthy volunteers served as control subjects.

RESULTS

Both MPI obtained by TDI and PD increased significantly in patients with ASD compared with control subjects (TDI: 0.41 +/- 0.07 vs. 0.32 +/- 0.04, P < 0.001; PD: 0.41 +/- 0.07 vs. 0.31 +/- 0.04, P < 0.001). There were highly significant correlations between MPI values obtained by TDI and by PD in patients with ASD and in control subjects, respectively (r = 0.46, P = 0.001; r = 0.72, P < 0.001, respectively). After transcatheter closure, the MPI obtained by TDI decreased markedly in patients with ASD (3 days after closure: 0.37 +/- 0.06, P = 0.004; 1 month after closure: 0.33 +/- 0.05, P < 0.001, respectively).

CONCLUSIONS

The TDI-derived MPI can be used to assess the global right ventricular function in patients with ASD. Compared with control subjects, the MPI was significantly higher in patients with ASD suggesting decreased right ventricular function. After transcatheter closure, the MPI decreased markedly and right ventricular function improved in patients with ASD.