Key result
In patients with atrial septal defects, those with higher baseline PVR (≥2 WU) experienced smaller increases in pulmonary blood flow following fluid challenge compared to those with lower PVR (0.3 vs 2.0 L/min, p<0.0001).
Why the study?
The role of fluid challenge and balloon occlusion in evaluating patients with operable atrial septal defects to unmask left ventricular disease and post-capillary pulmonary hypertension is not well established.
Does fluid challenge and balloon occlusion testing reveal hemodynamic differences in ASD patients with varying baseline pulmonary vascular resistance?
Observational (n=50)
Yes
Does fluid challenge and balloon occlusion testing reveal hemodynamic differences in ASD patients with varying baseline pulmonary vascular resistance?
Absolute Event Rate: 0.3% vs 2%
p-value: p=<0.0001
In adults with ASD without overt LV disease, fluid challenge combined with balloon occlusion testing unmasks significant hemodynamic differences, particularly in those with slightly elevated PVR.
Fluid challenge may unmask PVR-related hemodynamic differences in ASD; leaves open prospective validation before guiding management.
INTRODUCTION: Careful, stepwise assessment is required in all patients with atrial septal defect (ASD) to exclude pulmonary vascular or left ventricular (LV) disease. Fluid challenge and balloon occlusion may unmask LV disease and post-capillary pulmonary hypertension, but their role in the evaluation of patients with 'operable' ASDs is not well established. METHODS: We conducted a prospective study in three Italian specialist centres between 2018 and 2020. Patients selected for percutaneous ASD closure underwent assessment at baseline and after fluid challenge, balloon occlusion and both. RESULTS: Fifty patients (46 (38.2, 57.8) years, 72% female) were included. All had a shunt fraction >1.5, pulmonary vascular resistance (PVR) <5 Wood Units (WU) and pulmonary arterial wedge pressure (PAWP) <15 mm Hg. Individuals with a PVR ≥2 WU at baseline (higher PVR group) were older, more symptomatic, with a higher baseline systemic vascular resistance (SVR) than the lower PVR group (all p<0.0001). Individuals with a higher PVR experienced smaller increases in pulmonary blood flow following fluid challenge (0.3 (0.1, 0.5) vs 2.0 (1.5, 2.8) L/min, p<0.0001). Balloon occlusion led to a more marked fall in SVR (p<0.0001) and a larger increase in systemic blood flow (p=0.024) in the higher PVR group. No difference was observed in PAWP following fluid challenge and/or balloon occlusion between groups; four (8%) patients reached a PAWP ≥18 mm Hg following the addition of fluid challenge to balloon occlusion testing. CONCLUSIONS: In adults with ASD without overt LV disease, even small rises in PVR may have significant implications on cardiovascular haemodynamics. Fluid challenge may provide additional information to balloon occlusion in this setting.
No takes yet. Share an insight, caveat, or question.
D’Alto et al. (2021) conducted an observational in atrial septal defects (n=50). Higher baseline PVR (≥2 WU) vs. Lower baseline PVR (<2 WU) was evaluated on Increase in pulmonary blood flow following fluid challenge (p=<0.0001). In patients with atrial septal defects, those with higher baseline PVR (≥2 WU) experienced smaller increases in pulmonary blood flow following fluid challenge compared to those with lower PVR (0.3 vs 2.0 L/min, p<0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: