Baseline Invasive Hemodynamics Identify Patients at Risk for Suboptimal Clinical Response After Percutaneous Atrial...

Area of Science:

• Cardiology
• Interventional Cardiology
• Adult Congenital Heart Disease

Background:

• Clinical outcomes following transcatheter atrial septal defect (ASD) closure exhibit significant variability.
• Predictors for suboptimal responses after ASD closure are not well-established.

Purpose of the Study:

• To investigate if pre-closure invasive hemodynamic parameters can predict clinical response after percutaneous ASD closure.
• To identify hemodynamic factors associated with suboptimal clinical outcomes post-ASD closure.

Main Methods:

• Retrospective analysis of 204 adult patients undergoing percutaneous secundum ASD closure.
• Assessment of pre-closure invasive hemodynamic parameters: pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR).
• Clinical response categorized as improved, unchanged, or suboptimal (persistent/new dyspnea, new diuretic therapy).

Main Results:

• Patients with suboptimal response (14.2%) had higher baseline mPAP and PCWP.
• Multivariable analysis identified age and mPAP as independent predictors of suboptimal response.
• Mean pulmonary artery pressure demonstrated moderate discriminative ability (AUC, 0.794) for predicting suboptimal response.

Conclusions:

• Elevated baseline mean pulmonary artery pressure (mPAP) is significantly associated with suboptimal clinical response after percutaneous ASD closure.
• Invasive hemodynamic assessment, particularly mPAP, can aid in identifying high-risk patients.
• These findings support risk stratification for patients undergoing ASD closure.