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Assessment of long-term cardiac adaptation in adult patients with type II atrial septal defect

A cardiovascular magnetic resonance (CMR) study

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

In type II atrial septal defect (ASD) patients, the left-to-right (LR) shunt causes adaptation of the heart and circulation. The study objective was to evaluate with cardiovascular magnetic resonance imaging (CMR) the impact of LR shunt on left (LV) and right ventricular (RV) volumes, function, and myocardial strain.

Methods

Thirty-five patients (42 ± 17 years, 17 male) were compared to a control group (n = 40). Cine imaging was used to calculate ventricular volumes and ejection fraction (EF), global longitudinal (GLS) and circumferential strain (GCS), and longitudinal free wall (FWS) and interventricular septal (IVS) strain. Phase-contrast imaging was used to calculate pulmonary flow to systemic flow ratio (Qp/Qs).

Results

The LR shunt (Qp/Qs 2.2 ± 0.6) resulted in larger RV end-diastolic volume (EDVi) (152 ± 42 vs 82 ± 11 ml/m2), lower LV EDVi (72 ± 16 vs 83 ± 9 ml/m2), and higher RV/LV EDVi ratio (2.2 ± 0.5 vs 1.0 ± 0.1) than controls (all p < 0.001). Functionally, stroke volumes were larger in RV and lower in LV (both p < 0.001) with a strong trend toward lower RV EF in patients (p = 0.08). The LR shunt negatively impacted RV GLS (p = 0.03) but not RV GCS. Longitudinal IVS but not RV FWS were significantly lower in patients, i.e., p < 0.001, of longitudinal IVS. Shunt severity correlated with RV size and stroke volume, right atrial size, and pulmonary trunk diameter (all p < 0.001), but not with functional nor strain parameters.

Conclusion

Long-term cardiac adaptation in ASD patients, with RV overfilling and LV underfilling, has a negative impact on systolic RV performance, a phenomenon which likely can be attributed to longitudinal dysfunction of the interventricular septum.

Key Points

• An LR shunt in type II ASD patients causes cardiac remodeling characterized by RV overfilling and conversely underfilling of the left ventricle.

• At the long term, there is evidence of systolic dysfunction of the right ventricle in this group of patients.

• Septal dysfunction underlies the observed impairment in RV function.

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Abbreviations

AA:

Ascending aorta

ASD:

Atrial septal defect

CMR:

Cardiovascular magnetic resonance imaging

EDV:

End-diastolic volume

EDVi:

Indexed end-diastolic volume

EF:

Ejection fraction

EFSR:

Ejection fraction to global strain rate

ESV:

End-systolic volume

ESVi:

Indexed end-systolic volume

FWS:

Free wall strain

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

ICC:

Intraclass correlation coefficient

IVS:

Interventricular septal strain

LA:

Left atrium

LR:

Left to right

LV:

Left ventricle

PA:

Pulmonary artery

PT:

Pulmonary trunk

RA:

Right atrium

RV:

Right ventricle

SR:

Strain rate

SV:

Stroke volume

SVi:

Indexed stroke volume

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, KU Leuven - UZ Leuven, Leuven, Belgium

    Akito Hiraoka, Rolf Symons, Julie A. Bogaert & Jan Bogaert

  2. 2Ai-School of Technology, IPCA, Barcelos, Portugal

    Pedro Morais

  3. Department of Cardiovascular Sciences, KU Leuven – UZ Leuven, Herestraat 49, Leuven, Belgium

    Alexander Van De Bruaene & Werner Budts

  4. Department of Imaging and Pathology, KU Leuven – UZ Leuven, Herestraat 49, Leuven, Belgium

    Jan Bogaert

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  1. Akito Hiraoka
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Correspondence to Jan Bogaert.

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Hiraoka, A., Symons, R., Bogaert, J.A. et al. Assessment of long-term cardiac adaptation in adult patients with type II atrial septal defect. Eur Radiol 31, 1905–1914 (2021). https://doi.org/10.1007/s00330-020-07364-w

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  • DOI: https://doi.org/10.1007/s00330-020-07364-w

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