Exercise Capacity and Ventricular Remodeling after Transcatheter Ventricular Septal Defect Closure in Asymptomatic or Minimally Symptomatic Adolescents and Adults
Journal
Circulation: Cardiovascular Interventions
Journal Volume
13
Journal Issue
6
Date Issued
2020
Author(s)
Chiu H.-H.
Hsu J.-Y.
Lin S.-M.
Chang Y.-M.
Yang M.-C.
Abstract
Background: Transcatheter ventricular septal defect (VSD) closure is a safe and efficacious alternative to surgery. However, its benefits in asymptomatic or minimally symptomatic patients remain unknown. Methods: Sixty patients with VSD aged 12 to 60 years underwent cardiopulmonary exercise test and echocardiography 1 day before transcatheter VSD closure and 6 months after intervention (closure group). Thirty patients who did not receive the intervention underwent the same evaluations over 6 months (observation group). Results: No significant change in exercise function was observed after VSD closure, except for increased peak oxygen (O2) pulse (absolute increase: 0.4±1.4 mL/beat). Left ventricular end-diastolic dimension and mitral peak early filling velocity-to-early diastolic annular velocity ratio decreased (absolute decrease: 0.3±0.6 cm and 0.7±1.9, respectively). Despite unchanged overall peak O2consumption, 33% of closure group patients exhibited clinically significant improvements in peak O2consumption (>10% increase relative to baseline). This was not related to the pulmonary flow-to-systemic flow ratio or baseline exercise capacity. By contrast, all exercise function parameters deteriorated significantly in the observation group. Subgroup analysis revealed that patients with a baseline left ventricular end-diastolic dimension Z score of >2 exhibited a significantly greater improvement in peak O2consumption, peak O2pulse, and oxygen uptake efficiency slope than did the observation group. Conclusions: Compared with conservative management, transcatheter VSD closure prevents deterioration in exercise capacity and promotes left ventricular reverse remodeling in asymptomatic or minimally symptomatic patients. These benefits are most prominent in patients whose left ventricular end-diastolic dimension Z score before intervention is >2, irrespective of baseline peak O2consumption and pulmonary flow/systemic flow ratio. Registration: URL: Http://www.clinicaltrials.gov. Unique identifier: NCT03127748. ? 2020 Lippincott Williams and Wilkins. All rights reserved.
SDGs
Other Subjects
adenosine; amino terminal pro brain natriuretic peptide; oxygen; adolescent; adult; aortic valve prolapse; cardiopulmonary exercise test; cardiopulmonary function; child; conservative treatment; controlled study; echocardiography; Editorial; electrocardiography; exercise; female; follow up; heart catheterization; heart left ventricle enddiastolic diameter; heart left ventricle enddiastolic pressure; heart rate; heart ventricle remodeling; heart ventricle septum defect; human; interventional cardiovascular procedure; lung artery pressure; major clinical study; male; oxygen consumption; peak oxygen uptake; priority journal; supraventricular tachycardia; transcatheter ventricular septal defect closure; transesophageal echocardiography; transthoracic echocardiography; workload; adverse event; age; asymptomatic disease; complication; convalescence; diastole; exercise tolerance; heart catheterization; heart left ventricle function; heart septum defect; heart ventricle remodeling; middle aged; pathophysiology; prospective study; time factor; treatment outcome; young adult; Adolescent; Adult; Age Factors; Asymptomatic Diseases; Cardiac Catheterization; Child; Diastole; Exercise Tolerance; Female; Follow-Up Studies; Heart Septal Defects, Ventricular; Humans; Male; Middle Aged; Oxygen Consumption; Prospective Studies; Recovery of Function; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling; Young Adult
Publisher
Lippincott Williams and Wilkins
Type
editorial