Predictors of Increased Left Ventricular Filling Pressure After Transcatheter Atrial Septal Defect Closure

The aim of this study was to identify factors of left ventricular filling pressure (LVFP) elevation following transcatheter atrial septal defect (ASD) closure. The study involved 97 adult patients with sinus rhythm who underwent both transcatheter ASD closure and transthoracic echocardiography. Elevated LVFP was diagnosed during the first month of follow-up according to the American Society of Echocardiography guidelines: that is, ratio of transmitral early filling to the lateral annular diastolic velocity (lateral E/e') >13 was used to exclude the effect of the device on the atrial septum. Fifteen patients (15.5%) were diagnosed with increased LVFP during the 1-month follow-up period (median lateral E/e': from 9.2, IQR, 6.6-10.8; to 15.5, IQR, 13.8-17.8; P<0.001). Independent predictors of LVFP elevation were left ventricular (LV) relative wall thickness, lateral E/e›, and peak tricuspid regurgitation pressure gradient (TRPG) at baseline (OR, 1.67; 95% CI: 1.04-2.69; OR, 1.52; 95% CI: 1.07-2.15; and OR, 1.14; 95% CI: 1.04-1.25; cut-offs: 0.42, 7.5, and 27.0 mmHg, respectively). Median lateral E/e› returned to baseline in most patients with LVFP elevation during 6 months of subsequent follow-up (1-month-6-month follow-up: 15.5, IQR, 13.8-17.8; 11.1, IQR, 8.8-14.8, respectively; P=0.001). The increase in Doppler-estimated LVFP following transcatheter ASD closure may be related to LV hypertrophy, diastolic dysfunction, and peak TRPG in elderly patients.