Discordance between the European and the United States guideline criteria for atrial septal defect closure in adult patients with pulmonary hypertension and its clinical impact

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2024-09-27 DOI:10.1016/j.cpcardiol.2024.102869

Tarinee Tangcharoen MD , Tawai Ngernsritrakul MD , Mann Chandavimol MD , Chanankan Kamsorn BSc , Sanatcha Apakuppakul MD , Sukit Yamwong MD

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Abstract

Background

The criteria for ASD closure in patients with PAH are different between the AHA/ACC and the ESC guidelines. We aimed to study the prevalence of patients with different guideline criteria for ASD closure and its impact on the clinical outcome after closure.

Methods and results

A retrospective cohort study recruiting patients who underwent ASD closure from 2011–2020 was conducted in a single university hospital. Patients were grouped into ASD closure recommended (class I, class IIa, and class IIb) and ASD closure not recommended groups (class III). The primary outcome was the prevalence of patients with discordant criteria and the clinical outcomes and echocardiographic parameters after ASD closure. A total of 17 of 66 ASD patients (25.8 %) were diagnosed with ASD with pulmonary hypertension. Two patients were excluded due to incomplete right heart catheterization data. 13 patients (86.7 %) were classified as ASD-closure recommended group by both guidelines. Two patients, classified as class IIb by ACC/AHA guidelines, were unsuitable for ASD closure by ESC guidelines. After ASD closure, all 15 patients reported functional class improvement and no significant difference in the echocardiography parameters. However, the number of patients with a low probability of PHT was higher in patients with ESC guideline-recommended closure.

Conclusions

Most patients (86.7 %) are in concordant classification regarding ASD closure recommendations. The ESC guidelines are more restrictive than the AHA/ACC guidelines, allowing fewer patients for ASD closure. However, the clinical outcomes after ASD closure are not significantly different between these guidelines.

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欧洲和美国肺动脉高压成人患者房室隔缺损闭合指南标准的不一致及其临床影响。

背景：AHA/ACC和ESC指南中关于PAH患者ASD关闭的标准不同。我们的目的是研究ASD关闭标准不同的患者的患病率及其对关闭后临床结果的影响：我们在一家大学医院开展了一项回顾性队列研究，招募了 2011-2020 年间接受 ASD 闭合术的患者。患者被分为推荐的 ASD 闭合组（I 级、IIa 级和 IIb 级）和不推荐的 ASD 闭合组（III 级）。主要结果是标准不一致患者的发病率以及ASD关闭术后的临床结果和超声心动图参数。66 例 ASD 患者中，共有 17 例（25.8%）被诊断为 ASD 合并肺动脉高压。两名患者因右心导管检查资料不全而被排除在外。13名患者（86.7%）被两份指南列为ASD关闭推荐组。有两名患者被 ACC/AHA 指南列为 IIb 级，但根据 ESC 指南不适合进行 ASD 关闭术。关闭 ASD 后，所有 15 名患者的功能分级均有所改善，超声心动图参数也无明显差异。然而，在ESC指南推荐关闭的患者中，PHT可能性较低的患者人数较多：大多数患者（86.7%）的ASD关闭建议分类一致。ESC指南比AHA/ACC指南更严格，允许进行ASD闭合的患者更少。然而，这些指南对ASD闭合术后的临床结果并无明显差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.