Echocardiographic Estimates of Left Ventricular Diastolic Dysfunction Do Not Predict the Clinical Course in Elderly Patients Undergoing Transcatheter Atrial Septal Defect Closure: Impact of Early Diastolic Mitral Annular Velocity

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Geriatric Medicine

Background:

• Elderly patients undergoing transcatheter atrial septal defect (ASD) closure may be at risk for acute congestive heart failure due to left ventricular (LV) diastolic dysfunction.
• Limited data exists on the impact of severe LV diastolic dysfunction on outcomes after ASD closure in this population.

Purpose of the Study:

• To evaluate the effect of echocardiographic LV diastolic dysfunction on acute congestive heart failure following transcatheter ASD closure in patients over 60 years old.
• To assess changes in B-type natriuretic peptide (BNP) levels as an indicator of heart failure.

Main Methods:

• Two hundred elderly patients (>60 years) were stratified into three groups based on LV diastolic dysfunction severity: severe (e' <5.0 cm/s), mild (5.0 ≤ e' <8.0 cm/s), and normal (e' ≥8.0 cm/s).
• Plasma BNP levels were measured before and after the transcatheter ASD closure procedure.

Main Results:

• No patients with severe LV diastolic dysfunction experienced acute congestive heart failure immediately post-procedure.
• BNP levels remained stable in the severe LV diastolic dysfunction group, with no significant increase compared to baseline or other groups.
• The change in BNP levels in the severe group was comparable to those with mild or normal LV diastolic function, even in patients treated with diuretics.

Conclusions:

• Transcatheter ASD closure, when managed with appropriate volume control, is a safe and effective procedure for elderly patients, including those with severe LV diastolic dysfunction.
• The study suggests that pre-existing severe LV diastolic dysfunction does not preclude successful ASD closure without precipitating acute heart failure.