Quantitative Evaluation of Right Ventricular Myocardial Function Changes
in Patients with Atrial Septal Defect Before and After Occlusion by
Noninvasive Right Ventricular Pressure-Strain Loop
Abstract
Objective: The non-invasive right ventricular pressure-strain
loop (PSL) represents a novel method for the quantitative assessment of
right ventricular myocardial function. Given that atrial septal defect
(ASD) is a prevalent congenital heart anomaly associated with right
ventricular volume overload, this study aims to quantitatively assess
the myocardial function of the right ventricle in ASD patients pre- and
post-occlusion by noninvasive right ventricular PSL. Methods:
This study included thirty-six patients diagnosed with secundum atrial
septal defect (ASD group) and thirty healthy adults (control group). We
compared conventional right ventricular echocardiographic parameters,
right ventricular strain, and myocardial work in the ASD group before
occlusion, two days post-occlusion, and three months post-occlusion,
with those in the control group. Results: Prior to and two days
following occlusion, the ASD group exhibited higher right ventricular
global work index (RVGWI), right ventricular global wasted work (RVGWW),
and right ventricular global constructive work (RVGCW) compared to the
control group ( P < 0.05). Within the ASD group,
post-occlusion, RVGWI, RVGCW, and RVGWW values were significantly
reduced compared to pre-occlusion values ( P < 0.001).
Furthermore, RVGWI and RVGCW showed a significant decrease three months
after occlusion compared to two days post-occlusion ( P
< 0.05). Multivariate regression analysis identified ASD
diameter and pulmonary artery systolic pressure (PASP) as independent
predictors of RVGWI( β = 0.405, P < 0.001;
β=2.307， P=0.037) and RVGCW（β=0.350, P＜0.001; β=1.967,
P=0.023). Conclusions: The non-invasive right ventricular PSL
effectively demonstrates the alterations in right ventricular myocardial
function in ASD patients, pre- and post-occlusion. The metrics of right
ventricular myocardial work (RVMW) offer a novel indicator for
evaluating right ventricular myocardial function in these patients.
Moreover, ASD diameter and PASP emerge as independent determinants of
RVGWI and RVGCW.
