Assessment of right ventricular function by three-dimensional and myocardial imaging echocardiography after percutaneous atrial septal defect closure in adults

Purpose. The measurement of accurate right ventricular (RV) end-diastolic volume (EDV) is difficult because of RV complex geometry. Real-time three-dimensional (3D) echocardiography allows us to measure ventricular volume irrespective of its shape. Tissue Doppler imaging (TDI) and speckle tracking imaging (STI) are new tools to assess myocardial function. We sought to evaluate RV function by 3D and myocardial imaging echocardiography in adult patients with atrial septal defect (ASD) before and six months after transcatheter closure. Methods. Fifteen ASD patients were studied using a system equipped with a real-time X3 transducer (Vivid 9 ultrasound system, GE, Horten, Norway). Standard parameters of RV function (fractional area change, tricuspid annular plane systolic excursion -TAPSE-, Tei index) were obtained. RV and LV peak systolic velocities, peak systolic strain (), peak systolic strain rate (SR-S), and early (SR-E) and late (SR-A) diastolic strain-rate were obtained in the basal, mid and apical segments in apical 4-chamber view both by TDI and STI. Data were compared with those from 15 age-matched adults with patent foramen ovale selected as a control group. All measurements were taken from an acceptable tracing and determined using offline analysis programs (EchoPAC BT09, GE Ultrasound). Results. RV ejection fraction (3D-RVEF) was significantly larger compared to the control group and decreased significantly after closure (0.46± 0.11 vs 0.55±0.06, p<.01). 3D-EDV showed better correlations than 2D-EDV with the invasive and non-invasive parameters of RV function, suggesting the validity of volume measurement by 3D echocardiography. TAPSE decreased significantly (22.4±8.3 vs. 17.9±5.7 mm, p<.05) after interventional closure of the defect. Higher RV mid-segment peak systolic velocities were recorded, which returned to normal values after closure of the defect. Global longitudinal strain of the right ventricle was significantly higher than in the control group (223.4+4.5 vs. 221.4+4.3%, P , 0.05) and had a significant reduction after defect closure. Strain was reduced especially in RV median and apical lateral segments (median strain: -16.39±5.27 vs. -24.74±8.00, p=0.002; apical strain -13.01±6.84 vs. 22.53±11.32, p=0.03) with a very good correlation with RVEF (r=-0.717, p=0.0001). There was no significant change in the global RV strain-rate. By multivariate analysis, apical strain (p=0.004) and TAPSE (p=0.029) were predictive of a decreased 3D-RVEF. Conclusions. 3D and myocardial imaging echocardiography appear to be helpful for a quantitative assessment of RV function after ASD closure. Velocity parameters are the most dependent and strain-rate values the less dependent on RV volume overload.