Key result
An increase in pulmonary capillary wedge pressure >5.5 mmHg during balloon occlusion test predicted midterm heart failure deterioration after transcatheter ASD closure (AUC 0.886; P<0.001).
Why the study?
Midterm heart failure deterioration can occur after transcatheter atrial septal defect closure in adults, but whether hemodynamic changes during the procedure identify patients at risk was unknown.
Do hemodynamic changes during balloon occlusion test predict midterm heart failure deterioration in adults undergoing transcatheter atrial septal defect closure?
Observational (n=86)
Do hemodynamic changes during balloon occlusion test predict midterm heart failure deterioration in adults undergoing transcatheter atrial septal defect closure?
An increase in pulmonary capillary wedge pressure >5.5 mmHg during balloon occlusion test strongly predicts midterm heart failure deterioration after transcatheter ASD closure in adults.
Answers are grounded in this paper and cite their sources.
May identify high-risk adults for post-ASD closure HF; leaves open whether routine testing improves selection or outcomes.
OBJECTIVES: To investigate whether hemodynamic changes during balloon occlusion test (BOT) predict future heart failure (HF) deterioration after transcatheter atrial septal defect closure (tASD-closure). BACKGROUND: Midterm HF deterioration can sometimes occur after tASD-closure in adults. Whether hemodynamic changes during tASD-closure can help identify patients at risk is unknown. METHODS: This prospective observational study enrolled 86 consecutive adult patients who underwent tASD-closure. Hemodynamic parameters, including pulmonary capillary wedge pressure (PCWP), were measured at baseline, during BOT, and after tASD-closure. The changes in PCWP during BOT and after tASD-closure were defined as ΔPCWP (Occ-Pre) and ΔPCWP (Post-Pre), respectively. Clinical parameters were evaluated before tASD-closure and during the 3-month follow-up. We assessed the occurrence of HF deterioration (HF requiring hospitalization or additional diuretics) during a 2-year follow-up period and categorized patients into HF (+) and HF (-) groups accordingly. The aforementioned parameters were compared between groups. RESULTS: Midterm HF deterioration occurred in 12 patients (13.9%). Compared to the HF (-) group, the HF (+) group presented a significantly higher ΔPCWP (Occ-Pre) (9.5 ± 4.4 mmHg vs. 3.0 ± 3.3 mmHg; p < 0.001) and ΔPCWP (Post-Pre) (4.0 ± 2.8 mmHg vs. 0.6 ± 1.8 mmHg; p = 0.004). Receiver operating characteristic curve analysis showed that the ΔPCWP (Occ-Pre) cutoff value of 5.5 mmHg had excellent ability to predict HF deterioration (Area under the curve 0.886 [0.779-0.993], p < 0.001; sensitivity 0.917, specificity 0.824). CONCLUSIONS: Increases in PCWP during BOT predict midterm HF deterioration after tASD-closure. Close surveillance may be needed in patients with a ΔPCWP (Occ-Pre) >5 mmHg.
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Yamamoto et al. (2021) conducted an observational in Atrial septal defect (n=86). Change in pulmonary capillary wedge pressure during balloon occlusion test vs. Lower change in pulmonary capillary wedge pressure was evaluated on Heart failure deterioration (requiring hospitalization or additional diuretics) (AUC 0.886, 95% CI 0.779-0.993, p=<0.001). An increase in pulmonary capillary wedge pressure >5.5 mmHg during balloon occlusion test predicted midterm heart failure deterioration after transcatheter ASD closure (AUC 0.886; P<0.001).
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