Do patients over 40 years of age benefit from closure of atrial septal defects: a comparison of cardiac remodeling assessed by 2D-echocardiography and plasma NT-proBNP levels following ASD closure

  • Martin Wong, Sarawak General Hospital, Malaysia
  • Prashant Joshi, Sarawak General Hospital, Malaysia
  • Kimbee Lau, Sarawak General Hospital, Malaysia
  • Prof Kuihian Sim, Sarawak General Hospital, Malaysia

    • Objectives: Previous studies suggested patients over 40 years old do not benefit as much from atrial septal defects (ASD) closure compared to younger patients. We aimed to evaluate and compare the magnitude of cardiac remodeling following ASD among them.
    Methods: 20 patients (median age 27.6 years, range 6.5 to 64.6 years) with isolated ASD underwent ASD closure (6 transcatheter device closure, 14 surgical closure) and were studied. They were divided into two age groups: < 40 years (n = 15) and ≥ 40 years (n = 5). Plasma NT-proBNP levels and the following echocardiographic parameters were measured before, at 2 months and at 6 months after ASD closure: right atrial (RA) and left atrial (LA) sizes, right ventricular (RV) and left ventricular (LV) volume, LV ejection fractions (LVEF) and LV eccentric index.
    Results: RA size and RV volume decreased whereas LV volume, LVEF and LV eccentric indices increased significantly following ASD closure with similar magnitude of changes seen between the two age groups. The plasma NT-proBNP levels also decreased significantly (loge NT-proBNP values from 4.95 ± 1.28 pg/ml to 4.50 ± 1.01 pg/ml; p = 0.02). Similar trend of reduction was seen in both age groups and at 6 months, there was no difference in the plasma NT-proBNP levels between them (loge NT-proBNP values 4.34 ± 0.93 pg/ml versus 4.94 ± 1.19 pg/ml; p = 0.27).
    Conclusions: Patients above 40 years of age manifested similar degree of cardiac remodeling following ASD closure compared to younger patients.

    < 40 years ≥ 40 years Between age groups
    Paremeter Before After p value Before After p value p value
    RA size (cm2/m2) 17.0 ± 3.4 9.5 ± 1.9 0.043 20.0 ± 9.7 12.4 ± 4.7 < 0.001 0.931
    LA size (cm2/m2) 10.2 ± 3.1 10.2 ± 2.0 NS 12.6 ± 3.4 10.8 ± 1.9 NS 0.777
    RV volume (ml/m2) 112.0 ± 31.2 53.2 ± 18.5 0.005 109.9 ± 31.9 57.2 ± 19.0 < 0.001 0.487
    LV volume (ml/m2) 26.7 ± 8.4 48.9 ± 10.7 0.012 29.6 ± 12.2 53.4 ± 21.6 < 0.001 0.306
    LVEF (%) 45 ± 8 64 ± 9 0.020 44 ± 12 63 ± 10 < 0.001 0.927
    LV eccentric index 0.72 ± 0.09 0.94 ± 0.10 0.023 0.77 ± 0.11 1.02 ± 0.07 < 0.001 0.788