Benefit of atrial septal defect closure in adults: impact of age
Benefit of atrial septal defect closure in adults: impact of age
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DOI：
10.1093/eurheartj/ehq352
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发表时间：
2011-03-01
影响因子：
39.3
通讯作者：
Baumgartner, Helmut
中科院分区：
文献类型：
--
作者：
Humenberger, Michael;Rosenhek, Raphael;Baumgartner, Helmut
目的评估年龄对成人房间隔缺损（ASD）封堵术临床获益的影响。方法和结果功能状态、心律失常、右心室（RV）重构和肺动脉压（PAP）的存在在236例接受经导管ASD封堵术的连续患者中进行了研究[164例女性，平均年龄49 +/- 18岁，年龄小于40岁（A组）78例，40 - 60岁（B组）84例，60岁以上（C组）74例]。不同年龄组的缺损尺寸[中位数22 mm（四分位距，19，26 mm）]和分流率[Qp：Qs 2.2（1.7，2.9）]无差异。然而，老年患者的症状更严重，PAP（r = 0.65，P < 0.0001）和RV大小（r = 0.28，P < 0.0001）均与年龄显著相关。介入后，A、B和C组的RV尺寸分别从41 +/- 7、43 +/- 7和45 +/- 6 mm降至32 +/- 5、34 +/- 5和37 +/- 5 mm PAP分别从31 +/- 7、37 +/- 10和53 +/- 17 mmHg降至26 +/- 5、30 +/- 6和43 +/- 14 mmHg（P < 0.0001）。RV大小（P = 0.80）和PAP（P = 0.24）的绝对变化在组间无显著差异。A、B和C组干预前分别有13、49和83%的患者出现症状，干预后分别有3、11和34%的患者出现症状。功能状态与PAP.结论在任何年龄，ASD关闭后症状改善和PAP和RV大小的回归。然而，最好的结果是在功能障碍较少和PAP升高较少的患者中实现的。考虑到随着年龄的增长，症状、RV重塑和PAP的持续增加，即使是高龄成人，也必须在诊断后早期推荐ASD闭合术，而不考虑症状。
Aims To evaluate the effect of age on the clinical benefit of atrial septal defect (ASD) closure in adults.Methods and results Functional status, the presence of arrhythmias, right ventricular (RV) remodelling, and pulmonary artery pressure (PAP) were studied in 236 consecutive patients undergoing transcatheter ASD closure [164 females, mean age of 49 +/- 18 years, 78 younger than 40 years (Group A), 84 between 40 and 60 years (Group B) and 74 older than 60 years (Group C)]. Defect size [median 22 mm (inter-quartile range, 19, 26 mm)] and shunt ratio [Qp:Qs 2.2 (1.7, 2.9)] did not differ among age groups. Older patients had, however, more advanced symptoms and both, PAP (r = 0.65, P < 0.0001) and RV size (r = 0.28, P < 0.0001), were significantly related to age. Post-interventionally, RV size decreased from 41 +/- 7, 43 +/- 7, and 45 +/- 6 mm to 32 +/- 5, 34 +/- 5, and 37 +/- 5 mm for Groups A, B, and C, respectively (P < 0.0001), and PAP decreased from 31 +/- 7, 37 +/- 10, and 53 +/- 17 mmHg to 26 +/- 5, 30 +/- 6, and 43 +/- 14 mmHg (P < 0.0001), respectively. Absolute changes in RV size (P = 0.80) and PAP (P = 0.24) did not significantly differ among groups. Symptoms were present in 13, 49, and 83% of the patients before and in 3, 11, and 34% after intervention in Groups A, B, and C. Functional status was related to PAP.Conclusions At any age, ASD closure is followed by symptomatic improvement and regression of PAP and RV size. However, the best outcome is achieved in patients with less functional impairment and less elevated PAP. Considering the continuous increase in symptoms, RV remodelling, and PAP with age, ASD closure must be recommended irrespective of symptoms early after diagnosis even in adults of advanced age.