Does transcatheter closure of atrial septal defect improve cardiac remodeling and exercise capacity in patients older than 40 years with reduced cardiopulmonary function?
Transcatheter ASD closure in middle-aged and elderly patients with reduced cardiopulmonary function leads to early reverse cardiac remodeling and delayed but significant improvement in exercise capacity.
BACKGROUND: Although it has been demonstrated that cardiac remodeling and exercise capacity improve after transcatheter closure of atrial septal defect (ASD), little is known about long-term benefits in middle-aged and elderly patients with a reduction in cardiopulmonary function. OBJECTIVES: To evaluate long-term extent and time course of improvements in cardiac remodeling and exercise capacity in those patients. METHODS: Twenty ASD patients ≥ 40 years of age with a reduction in cardiopulmonary function (predicted peak oxygen uptake VO(2) 12 months after the procedure. RESULTS: At 1 month after the procedure, significant decreases in right ventricular (RV) end-diastolic diameter (38.2 ± 4.4 to 31.9 ± 4.4 mm; P < 0.001) and RV/left ventricular end-diastolic diameter ratio (0.95 ± 0.17 to 0.71 ± 0.13; P < 0.001) occurred, and they were maintained during the follow-up period. Normal RV size was achieved in 11 of 18 patients with RV enlargement. Predicted peak VO(2) did not change at 1 month and 3 months, but it improved significantly after 6 months (53.6 ± 6.5 to 62.1 ± 12.6%; P < 0.01). Sixteen of the 20 patients showed improved predicted peak VO(2). CONCLUSIONS: Cardiac remodeling and exercise capacity could be improved over the long-term period after transcatheter closure of ASD in middle-aged and elderly patients with a reduction in cardiopulmonary function. There were differences in the time course of improvement between cardiac remodeling and exercise capacity in those patients.
Takaya et al. (Mon,) studied this question.