The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Usefulness of mean pulmonary artery pressure for predicting outcomes of transcatheter closure of atrial septal defect with pulmonary arterial hypertension

DOI: 10.4244/EIJ-D-19-00172

1. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
2. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
3. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
4. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
5. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
6. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
7. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
8. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China, CHINA
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Aims:This study aimed to provide a simple index for predicting the definite indication for transcatheter closure of atrial septal defect (ASD) with pulmonary arterial hypertension(PAH)

Methods and results:A positive responseafter attempted occlusion was defined as mean pulmonary artery pressure (MPAP) ≤ 30 mmHg or the decrement percentage of it ≥20% compared with the baseline. If a positive response was achieved, the occluder would be released, and the procedure was defined as successful. In 209 patients underwent successful procedure without PAH-specific medicine, there was a dramatic decrease in the percentage of patients with pulmonary arterial systolic pressure (PASP) ≥ 50 mmHg from baseline to the one-year follow-up (79.4% to 14.0%, P<0.001). The optimalcut-offvalue of MPAP to predict a positive response without PAH-specific medicine was 35.0 mmHg, with an area under the curve (AUC) of 0.919 (P <0.001). Administration of inhaled iloprost extended the cut-off point to 50.0 mmHg to reach a positive response, with an AUC of 0.774 (P=0.003). 

Conclusions: This large-scale studyindicated that MPAP could be a simple but powerful index to predict benefit from closure in adult ASD patients with PAH.

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