Interventions for hypertension and stroke

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

EuroIntervention 2020;16:e1029-e1035. DOI: 10.4244/EIJ-D-19-00172

Wenzhi Pan
Wenzhi Pan1, MD; Yuan Zhang1, MD; Lihua Guan1, MB; Xiaochun Zhang1, MB; Lei Zhang1, MD; Lifan Yang1, MD; Junbo Ge1, MD, FACC; Daxin Zhou1, MD, FACC
1. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China

Aims: This study aimed to provide a simple index for predicting the definitive indication for transcatheter closure of atrial septal defect (ASD) with pulmonary arterial hypertension (PAH).

Methods and results: A positive response after attempted occlusion was defined as mean pulmonary artery pressure (MPAP) ≤30 mmHg or the decrement percentage of it ≥20% compared with baseline. If a positive response was achieved, the occluder would be released, and the procedure was defined as successful. In 209 patients who underwent a 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 optimal cut-off value 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 study indicated that MPAP could be a simple but powerful index to predict benefit from closure in adult ASD patients with PAH.

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atrial septal defectclinical researchpulmonary hypertension
Interventions for valvular diseaseOther valvular and structural interventions
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