Temporal profile of right and left ventricular wall deformation analysis using 2D speckle tracking echocardiography following atrial septal defect closure.

Abstract

Background: Analysing temporal strain changes in right ventricular (RV) and left ventricular (LV) walls post-atrial septal defect (ASD) closure is of clinical importance.

Aims: We aimed to evaluate acute/short-term changes in RV/LV wall deformation after ASD closure using two-dimensional speckle tracking echocardiography (2D-STE).

Methods: A total of 43 patients with ASD and 20 controls had echocardiograms before and after ASD closure.

Results: Of the 43 patients with secundum ASD (mean age 27.37 years), 48.8% were closed surgically, while 51.2% underwent device closure. At baseline, LV global longitudinal strain (GLS; 2-chamber view GLS: 16.95% vs 20.73%; p=0.0001, apical long-axis view GLS 16.48% vs 20.90%; p=0.0001, 4-chamber view GLS 16.93% vs 21.56%; p=0.0001, average GLS 16.75% vs 21.31%; p=0.0001) and RV GLS (19.22% vs 24.27%; p=0.0001) were significantly lower in the patients with ASD compared to controls. After closure, the average LV GLS rapidly improved at 24 hours from baseline (16.75% to 17.28%; p=0.004), with sustained increases at 1 and 3 months (18.16% and 19.40%; p=0.001). The mean RV GLS also improved at all serial timepoints (baseline, 24 hrs, 1 month, and 3 months) with values of 19.22%, 19.85%, 20.70%, and 22.23%, respectively (p=0.0001). As compared to surgery, LV GLS and RV GLS were much better in the device group (average LV GLS at 24 hrs, 1 month, and 3 months: 16.54% vs 17.98%, 17.34% vs 18.92%, and 18.80% vs 19.96%, respectively; mean RV GLS at 24 hrs, 1, and 3 months: 17.83% vs 21.78%, 18.73% vs 22.58%, and 20.70% vs 23.70%, respectively).

Conclusions: This GLS study demonstrates significant reverse remodelling of both the RV and LV after ASD closure. Device closure was associated with superior strain rate recovery compared to surgery at the 3-month midterm follow-up.