A baseline mean pulmonary artery pressure cut-off of 35.0 mmHg strongly predicted a positive response to transcatheter ASD closure without PAH-specific medicine (AUC 0.919, p<0.001).
Cohort (n=209)
Can mean pulmonary artery pressure (MPAP) predict a positive response to transcatheter closure in adult patients with atrial septal defect and pulmonary arterial hypertension?
Mean pulmonary artery pressure (MPAP) with a cut-off of 35.0 mmHg (or 50.0 mmHg with inhaled iloprost) is a strong predictor of successful transcatheter closure in adult ASD patients with PAH.
Absolute Event Rate: 14% vs 79.4%
p-value: p=<0.001
AIMS: This study aimed to provide a simple index for predicting the definitive indication for transcatheter closure of atrial septal defect (ASD) with pulmonary arterial hypertension (PAH). METHODS AND RESULTS: A positive response after attempted occlusion was defined as mean pulmonary artery pressure (MPAP) ≤30 mmHg or the decrement percentage of it ≥20% compared with baseline. If a positive response was achieved, the occluder would be released, and the procedure was defined as successful. In 209 patients who underwent a successful procedure without PAH-specific medicine, there was a dramatic decrease in the percentage of patients with pulmonary arterial systolic pressure (PASP) ≥50 mmHg from baseline to the one-year follow-up (79.4% to 14.0%, p<0.001). The optimal cut-off value of MPAP to predict a positive response without PAH-specific medicine was 35.0 mmHg, with an area under the curve (AUC) of 0.919 (p<0.001). Administration of inhaled iloprost extended the cut-off point to 50.0 mmHg to reach a positive response, with an AUC of 0.774 (p=0.003). CONCLUSIONS: This large-scale study indicated that MPAP could be a simple but powerful index to predict benefit from closure in adult ASD patients with PAH.
Pan et al. (Tue,) conducted a cohort in Atrial septal defect with pulmonary arterial hypertension (n=209). Transcatheter closure of atrial septal defect vs. Baseline was evaluated on Pulmonary arterial systolic pressure (PASP) ≥50 mmHg (p=<0.001). A baseline mean pulmonary artery pressure cut-off of 35.0 mmHg strongly predicted a positive response to transcatheter ASD closure without PAH-specific medicine (AUC 0.919, p<0.001).