Key result
Persistent AF before ASD closure linked to ~118% greater risk of late PAH.
Why the study?
The study aimed to evaluate pulmonary artery systolic pressure course, identify factors associated with pulmonary arterial hypertension, and determine the impact of atrial septal defect closure on long-term clinical outcomes.
What are the predictors of pulmonary arterial hypertension after atrial septal defect closure in adults?
Cohort (n=547)
What are the predictors of pulmonary arterial hypertension after atrial septal defect closure in adults?
Hazard Ratio: 2.18 (95% CI 1.21–3.91)
Absolute Event Rate: 62.9% vs 9.2%
p-value: p=0.009
Persistent atrial fibrillation, older age, and greater right ventricular basal diameter are significant predictors of late pulmonary arterial hypertension following atrial septal defect closure in adults.
Retrospective ASD closure data in adults with PAH; leaves open the need for prospective trials to guide practice.
Background: In this study, we aimed to evaluate the course of pulmonary artery systolic pressure, to identify factors associated with pulmonary arterial hypertension, and to determine the impact of atrial septal defect closure on clinical outcomes in long-term follow-up. Methods: Between March 2008 and August 2020, a total of 547 adult patients (193 males, 354 females; median age: 37 years; range, 27.5 to 47 years) with secundum atrial septal defect were retrospectively analyzed. Of these patients, 304 underwent percutaneous defect closure and 243 underwent isolated surgical repairs. Pulmonary arterial hypertension was defined as a noninvasively estimated pulmonary artery systolic pressure of ≥40 mmHg at the final follow-up after atrial septal defect closure. Factors associated with pulmonary arterial hypertension were analyzed. Results: Sixty-nine (12.6%) patients presented with pulmonary arterial hypertension at the final follow-up. A total of 35 (6.4%) patients had persistent atrial fibrillation before atrial septal defect closure, and 22 of these 35 patients had pulmonary arterial hypertension during long-term follow-up. Older age at the time of atrial septal defect closure (HR: 4.76; 95% CI: 2.68-8.44; p<0.001), the presence of persistent atrial fibrillation (HR: 2.18; 95% CI: 1.21-3.91; p=0.009), and greater right ventricular basal diameter (HR: 4.78; 95% CI: 2.57-8.84; p<0.001) were found to be associated with late pulmonary arterial hypertension. Conclusion: The presence of persistent atrial fibrillation may be used to predict patients at higher risk for pulmonary arterial hypertension after atrial septal defect closure.
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Çelık et al. (2022) conducted a cohort in secundum atrial septal defect (n=547). Persistent atrial fibrillation vs. Absence of persistent atrial fibrillation was evaluated on late pulmonary arterial hypertension (HR 2.18, 95% CI 1.21-3.91, p=0.009). Persistent atrial fibrillation before atrial septal defect closure was associated with an increased risk of late pulmonary arterial hypertension (HR 2.18; 95% CI 1.21-3.91; p=0.009).
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