Assessment of right atrial function with speckle tracking echocardiography after percutaneous closure of an atrial septal defect | Revista Portuguesa de Cardiologia (English edition)

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The white arrows indicate the strength of myocardial contraction and the crimson arrows indicates passive movement of right atrium." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lígia Mendes, Nuno Cardim" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Lígia" "apellidos" => "Mendes" ] 1 => array:2 [ "nombre" => "Nuno" "apellidos" => "Cardim" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303793?idApp=UINPBA00004E" "url" => "/21742049/0000003600000012/v1_201712220644/S2174204917303793/v1_201712220644/en/main.assets" ] ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Assessment of right atrial function with speckle tracking echocardiography after percutaneous closure of an atrial septal defect" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "895" "paginaFinal" => "900" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Onder Ozturk, Unal Ozturk, Sengul Ozturk" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Onder" "apellidos" => "Ozturk" "email" => array:1 [ 0 => "droozturk21@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Unal" "apellidos" => "Ozturk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Sengul" "apellidos" => "Ozturk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Cardiology, Diyarbakir, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Neurology, Diyarbaki, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Archives and Dicle University Agricultural Faculty, Department of Plant Protection,, Diyarbakir, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Avaliação da função auricular direita por ecocardiograma com speckle tracking após encerramento percutâneo de comunicação interauricular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1877 "Ancho" => 2500 "Tamanyo" => 411734 ] ] "descripcion" => array:1 [ "en" => "Right atrial longitudinal strain imaging." ] ] ] "textoCompleto" => "IntroductionAtrial septal defect (ASD) accounts for 25-30% of congenital heart defects diagnosed during adulthood.<a class="elsevierStyleCrossRef" href="#bib0135">1</a> Ostium secundum ASD is the most common type, constituting 70% of all ASDs and 6-10% of all congenital heart defects. Left atrial (LA) and right atrial (RA) diameters and volumes are increased in ASD patients due to volume overload. ASDs cause a left-to-right shunt and chronic right chamber volume overload that can result in severe pulmonary hypertension and right heart failure. Secundum ASDs are centrally located and generally bounded by the superior and inferior limbic bands, which often makes these defects amenable to device closure.<a class="elsevierStyleCrossRefs" href="#bib0140">2,3</a>In the absence of fixed pulmonary hypertension, percutaneous ASD closure is associated with improvements in right ventricular dimensions, morphology and function and exercise physiology, and reverse right ventricular (RV) remodeling.<a class="elsevierStyleCrossRef" href="#bib0145">3</a> However, such adaptations can be incomplete or delayed in adult patients, and atrial changes post-ASD closure are poorly understood.<a class="elsevierStyleCrossRef" href="#bib0150">4</a>New echocardiographic methods have been developed to quantify left and right ventricular function and are important for diagnostic and prognostic assessment in various cardiovascular diseases.<a class="elsevierStyleCrossRefs" href="#bib0155">5,6</a> A new echocardiographic technique, two-dimensional (2D) speckle tracking echocardiography (STE), is capable of angle-independent tracking of myocardial deformation, enabling non-invasive and quantitative assessment of global and regional myocardial function.<a class="elsevierStyleCrossRef" href="#bib0165">7</a>Myocardial STE measures tissue deformation within the myocardium expressed as a percentage change. Myocardial tissue lengthening and shortening give positive and negative strain values, respectively. Strain rate measures the local rate of myocardial deformation per time unit. The global strain or strain rate is calculated by computing deformation along the entire myocardial line length.<a class="elsevierStyleCrossRefs" href="#bib0170">8,9</a> This new echocardiographic method is frequently used to assess left ventricular (LV) myocardial function, but has rarely been used to examine RA and RV myocardial function. Myocardial strain and strain rate can be used to investigate RA myocardial function during each phase of the cardiac cycle. Padeletti et al. showed that RA speckle tracking analysis is significantly correlated with systolic pulmonary artery pressure and pulmonary arterial hypertension secondary to LV systolic dysfunction. They also found that assessment of RA longitudinal strain can identify pulmonary artery hypertension in congestive heart failure patients.<a class="elsevierStyleCrossRef" href="#bib0180">10</a>The objective of the present study was to evaluate RA function by quantifying longitudinal RA strain in patients with chronic RV volume overload due to an ostium secundum ASD before and after percutaneous closure.MethodsPatientsPatients with secundum ASD admitted to our center for percutaneous closure between June 2013 and December 2015 were included in this prospective controlled study. A total of 38 consecutive patients with secundum type ASD were investigated. The clinical indication for ASD closure was a hemodynamically significant left-to-right shunt (Qp/Qs >2.0) or echocardiographic signs of right heart dilation or shunt-related symptoms. Patients with a stretched ASD larger than 36 mm, those with inadequate atrial septal rims to permit stable device deployment, those in whom the defect was close to the AV valves, coronary sinus or vena cavae, and those with sinus venosus or primum ASD, pulmonary vascular resistance greater than eight Wood units despite 100% oxygen, other concomitant congenital heart disease, valvular heart disease, coronary artery disease, LV systolic dysfunction, atrial fibrillation, or hypertension were excluded. Six patients were not suitable for percutaneous ASD closure and so the study population consisted of 32 patients (23 female, nine male, mean age 41±13 years) with secundum type ASD and in sinus rhythm who underwent successful percutaneous ASD closure.The study participants underwent clinical and echocardiographic assessment before and one month after percutaneous closure ASD. The study was approved by the local ethics committee of our hospital.Echocardiographic examinationAll patients underwent comprehensive transthoracic echocardiographic examinations at rest according to the American Society of Echocardiography guidelines,<a class="elsevierStyleCrossRef" href="#bib0185">11</a> using a Philips EPIQ 7C ultrasound system (Philips Healthcare, Andover, MA, USA) equipped with a multifrequency transducer (3-8 MHz) and tissue harmonic imaging capability. A single-lead electrocardiogram was recorded continuously and 2D echocardiographic images of the right atrium and right ventricle were obtained in apical 4-chamber view at end-expiration. Care was taken to capture the entire right atrium, allowing for more reliable delineation of the atrial endocardial border. The frame rate was set at between 40 and 80 frames per second. At least three consecutive cardiac cycles of 2D echocardiographic images recorded in apical 4-chamber view were stored in order to select the images with the best quality for off-line speckle tracking analysis.<a class="elsevierStyleCrossRef" href="#bib0190">12</a>Two-dimensional speckle tracking analysisTwo-dimensional strain and strain rate analysis is a reliable technique for tracking of myocardial movement and deformation. Standard grayscale images are analyzed with a dedicated software package that focuses on specific speckle patterns and follows them on a frame-by-frame basis during a cardiac cycle.<a class="elsevierStyleCrossRef" href="#bib0155">5</a> In contrast to Doppler-derived indices, STE has the advantage of being angle-independent, and is less affected by reverberations, side lobes and dropout artifacts.<a class="elsevierStyleCrossRef" href="#bib0190">12</a> STE is frequently used to assess LV function and in recent years has been used to quantify longitudinal myocardial LA and RA deformation dynamics.<a class="elsevierStyleCrossRefs" href="#bib0195">13,14</a>Speckle tracking analysis was performed by a single experienced and independent investigator (OO) who was blinded to the clinical data, using commercially available semiautomated 2D wall motion tracking software (Philips Healthcare Systems). To assess RA myocardial function, the RA endocardium was manually traced when the right atrium was at its maximum volume, just before tricuspid valve opening, as identified in apical 4-chamber view. The RA basal septal, basal lateral and apical borders were manually traced, followed by automatic tracing of the endocardial and epicardial borders, thus delineating a region of interest composed of six segments. After analysis of segmental tracking quality and manual adjustment of the region of interest, longitudinal strain curves were generated by the software for each atrial segment. A cine loop preview feature enabled visual confirmation that the internal line followed the movements of the RA endocardium throughout the cardiac cycle. If tracking of the RA endocardium was unsatisfactory, manual adjustments of the region of interest size were performed to ensure optimal tracking (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). RA longitudinal strain was measured in six segments of the atrium. As previously described, peak RA longitudinal strain at the end of the RA reservoir phase was calculated by averaging the values for all RA segments to yield global RA longitudinal strain.<a class="elsevierStyleCrossRefs" href="#bib0180">10,12</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Percutaneous atrial septal defect closure procedurePercutaneous ASD closure was performed under general anesthesia utilizing fluoroscopic and multiplane transesophageal echocardiographic (TEE) guidance. Closure was achieved using Figulla Flex II ASD devices (Occlutech GmbH, Jena, Germany). The larger diameters of the ASD were measured at different angles of 2D and three-dimensional TEE and device size was determined by adding 2-4 mm to the larger ASD diameter. In addition, the distance to the defect was required to be at least 5 mm from the mitral valve, right upper pulmonary vein, coronary sinus, tricuspid valve, inferior vena cava, and superior vena cava. In the case of deficient aortic rim (<5 mm), percutaneous closure was performed if the other rims had sufficient length. Balloon measurements were not performed routinely.<a class="elsevierStyleCrossRefs" href="#bib0190">12,13</a> Post-interventional treatment included 100 mg/day aspirin and 75 mg/day clopidogrel for six months.Statistical analysisStatistical analysis was performed with the SPSS statistical package, version 12.0 (SPSS Inc.). Continuous variables were expressed as mean ± SD and categorical variables were expressed as percentages. Intra-observer variability was calculated as the absolute difference between two measurements in percentage of their mean. The Student's t test and the chi-square test were used for comparison of data, as appropriate. Differences between baseline and follow-up were analyzed by the paired sample t test. Pearson correlation analysis was used to determine the relationship between RA longitudinal strain and other echocardiographic parameters. A p value <0.05 was considered statistically significant.ResultsBaseline demographic characteristics and procedure-related clinical parameters of the study population are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean native secundum ASD diameter on color Doppler echocardiographic assessment was 14±5 mm (10-22 mm) and the mean diameter of the closure devices used was 18.5±7.5 mm (14-28 mm). Percutaneous closure was performed successfully in all 32 patients. There was no residual ASD in any of the patients on echocardiographic assessment at one month after the procedure. The echocardiographic measurements are given in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. RV end-diastolic diameters were significantly increased but decreased significantly after ASD closure (43±5 vs. 38±4 mm, p<0.05). LA diameters (40±8 vs. 37±6 mm, p<0.05) decreased significantly after the intervention, whereas LV end-diastolic diameters (45±5 vs. 46±4 mm, NS) remained unchanged. Tricuspid annular plane systolic excursion (TAPSE) increased significantly (17.6±5.4 vs. 22.3±8.1 mm, p<0.05). After closure of the defect, a significant increase was observed in longitudinal RA strain (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Intra-observer variability for RA longitudinal strain was 3.2+1.6%.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Correlation analysis was performed between post-ASD and pre-ASD parameters. The delta value was calculated as post-ASD parameter minus pre-ASD parameter. The analysis showed negative correlations between delta RA longitudinal strain and delta RV diameter, delta RA diameter and delta pulmonary artery systolic pressure (PASP). Also, a positive correlation was found between delta RA longitudinal strain and delta TAPSE. However, there was no correlation between delta RA longitudinal strain and delta LVEF, delta LV diameter or delta LA diameter (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionThe right atrium has multiple important roles during the cardiac cycle: it functions as a reservoir for systemic venous return when the tricuspid valve is closed, provides a passive conduit for blood flow during early diastole when the tricuspid valve opens, and actively expels blood during late diastole with atrial contraction.<a class="elsevierStyleCrossRef" href="#bib0165">7</a> The right atrium has an unusual geometry and thin walls. Assessment of atrial dimensions and volume using 2D echocardiographic parameters has limitations. Measurement of atrial dimensions with M-mode and 2D echocardiography assumes the atria have an elliptical geometry,<a class="elsevierStyleCrossRef" href="#bib0205">15</a> but this is clearly not completely true, and the variable and non-uniform geometry of the atria leads to significant differences in the measurement of atrial volumes using the biplane area-length method and biplane modified Simpson's rule.<a class="elsevierStyleCrossRef" href="#bib0205">15</a> Anatomical and functional assessment of the RA is therefore difficult.<a class="elsevierStyleCrossRefs" href="#bib0210">16–18</a> In previous studies, 2D transthoracic echocardiographic measurements in patients with ASD demonstrated enlarged right atrium, right ventricle, and pulmonary arteries. These usually correlate with the magnitude of the left-to-right shunt.<a class="elsevierStyleCrossRef" href="#bib0225">19</a> In the past decade, the novel echocardiographic technique of strain imaging has been used to make more accurate assessments of myocardial function.<a class="elsevierStyleCrossRef" href="#bib0230">20</a> STE has been used in a wide range of cardiovascular conditions, including hypertension, heart failure and myocardial infarction.<a class="elsevierStyleCrossRefs" href="#bib0235">21,22</a> Conventional ways of determining systolic function rely on visual assessment of wall motion and changes in volume. However, STE measures actual tissue deformation within the myocardium.<a class="elsevierStyleCrossRef" href="#bib0185">11</a>One of the new applications of STE is in assessment of RA myocardial function. The RA reservoir phase is a dynamic phase of the cardiac cycle. RA deformation is dependent on preload and afterload, which affect the right ventricle and consequently influence the right atrium. We therefore assessed RA myocardial function in patients with percutaneous ASD closure by focusing on the reservoir phase.Two-dimensional STE assessment of RA myocardial function is feasible throughout the cardiac cycle. Peak RA longitudinal strain determines the reservoir phase.<a class="elsevierStyleCrossRef" href="#bib0165">7</a> Padeletti et al. reported that RA STE significantly correlated with pulmonary pressure. They also found that RA assessment with STE can predict pulmonary artery hypertension in heart failure patients.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> We demonstrated that peak RA longitudinal strain increased significantly after percutaneous closure of secundum ASD. Our study is the first to assess the effect of percutaneous ASD closure on RA function with STE. Sakata et al. reported that RA longitudinal strain was useful for noninvasive assessment of RA dysfunction in patients with pulmonary artery hypertension. They also found that peak global RA longitudinal strain was correlated with cardiac index. Peak global RA longitudinal strain can be thus useful for the assessment of RA overload and dysfunction in pulmonary artery hypertension. This study showed an inverse correlation between PASP and peak global RA longitudinal strain.<a class="elsevierStyleCrossRef" href="#bib0165">7</a>In our study, there was improvement in multiple echocardiographic parameters, including RV end-diastolic diameter, RA diameter, RV/LV end-diastolic diameter ratio, LA diameter and PASP at one month post-procedure. LV end-diastolic diameter and LV end-systolic diameter remained unchanged in the first month post-procedure, while LVEF and TAPSE were significantly increased. In this study, there was a positive correlation between delta RA longitudinal strain and delta LVEF and TAPSE and a negative correlation between delta RA longitudinal strain and delta RV myocardial performance index, RV diameter, RA diameter and PASP. Our finding of decreased RA and LA dimensions after percutaneous ASD closure is in agreement with similar reports in previous studies. For example, Akula et al. found a significant decrease in RV volumes in the first month after ASD closure that continued up to six months,<a class="elsevierStyleCrossRef" href="#bib0245">23</a> and Veldtman et al. found that right heart morphology undergoes rapid improvement within one month of percutaneous ASD closure.<a class="elsevierStyleCrossRef" href="#bib0250">24</a> Atashband et al. showed that percutaneous ASD closure in adults is effective, leading to reverse remodeling and better functional capacity,<a class="elsevierStyleCrossRef" href="#bib0255">25</a> while Thilén et al. found that cardiac remodeling after ASD closure in the adult is common and is generally completed within the first half year after closure.<a class="elsevierStyleCrossRef" href="#bib0260">26</a>Study limitationsSTE can be used for myocardial assessment in all dimensions (longitudinal, radial, and circumferential). In our study, we measured RA longitudinal strain only. Only one cardiac cycle was studied, and so respiratory variations may be a source of sample error. The software used for STE analysis was originally designed for the left ventricle, but in the present study it was applied to the right atrium. Defects in the atrial septum and the presence of an occlusion device may have affected RA longitudinal strain values.ConclusionVolume overload is associated with decreased strain values, which return to normal when the volume overload is abolished. In this study, RA longitudinal strain measured by 2D-STE was useful to assess the effect of percutaneous ASD closure on RA dysfunction in the reservoir phase. STE can be considered a feasible and reproducible noninvasive technique for the assessment of RA longitudinal deformation dynamics in patients with ASD.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres959880" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec930783" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres959881" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec930784" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Echocardiographic examination" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Two-dimensional speckle tracking analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Percutaneous atrial septal defect closure procedure" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-06-28" "fechaAceptado" => "2017-06-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec930783" "palabras" => array:4 [ 0 => "Congenital heart disease" 1 => "Right atrium" 2 => "Echocardiography" 3 => "Atrial septal defect" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec930784" "palabras" => array:4 [ 0 => "Doença cardíaca congénita" 1 => "Aurícula direita" 2 => "Ecocardiografia" 3 => "Comunicação interauricular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionSpeckle tracking echocardiography (STE) for two-dimensional (2D) strain analysis is a new tool to assess myocardial function. The aim of this study was to assess right atrial (RA) function using STE in patients with an atrial septal defect (ASD) before and one month after percutaneous closure. MethodsWe prospectively examined 32 consecutive patients (nine male, 23 female) who underwent percutaneous transcatheter closure of a secundum ASD between June 2013 and December 2015. Echocardiography was performed on admission, prior to cardiac catheterization and then one month after ASD closure. Peak global RA longitudinal strain was analyzed by 2D-STE. ResultsPatients’ mean age was 34.6±8.2 years. The mean diameter of the occlusive devices was 18.5±7.5 mm. Right ventricular (RV) end-diastolic diameters were significantly increased but decreased significantly after ASD closure (43±5 vs. 38±4 mm, p<0.05). Left atrial (LA) diameters (40±8 vs. 37±6 mm, p<0.05) decreased significantly after the intervention, whereas left ventricular (LV) end-diastolic diameters (45±5 vs. 46±4 mm, NS) remained unchanged. Tricuspid annular plane systolic excursion increased significantly (17.6±5.4 vs. 22.3±8.1 mm, p<0.05). After closure of the defect, a significant increase was observed in longitudinal RA strain (26.5±9.6% vs. 35.3±10.5%, p<0.001). ConclusionsAfter percutaneous transcatheter closure of a secundum ASD, there was an increase in RA longitudinal strain. 2D-STE strain analysis appears to be helpful for the assessment of RA function and of response to correction of volume overload after percutaneous transcatheter closure of a secundum ASD." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "IntroduçãoO speckle tracking por ecocardiograma (STE) ou a avaliação do strain em 2 D são novas ferramentas para a avaliação da função miocárdica. O objetivo deste estudo foi avaliar a função da aurícula direita (AD) com o uso de STE em doentes com comunicação interauricular antes e um mês após o encerramento percutâneo. MétodosAvaliamos prospetivamente 32 doentes consecutivos (nove homens, 23 mulheres) submetidos a encerramento percutâneo de comunicação interauricular (CIA) do tipo ostium secundum, entre junho de 2013 e dezembro de 2015. O ecocardiograma foi feito previamente ao procedimento e um mês após o encerramento da CIA. Foi avaliado o strain longitudinal global da AD (RALS) por 2D-STE. ResultadosA idade média dos doentes foi de 34,6±8,2 anos. O diâmetro médio dos dispositivos empregados foi de 18,5±7,5 mm. Os diâmetros telediastólicos do ventrículo direito (VD) eram significativamente maiores e diminuíram após encerramento da CIA (43±5 versus 38±4 mm, p<0,05). O diâmetro da aurícula esquerda (AE) diminuiu significativamente após a intervenção (40±8 versus 37±6 mm, p<0,05), enquanto que o diâmetro telediastólico do ventrículo esquerdo permaneceu igual (45±5 versus 46±4 mm, NS). O TAPSE aumentou significativamente (17,6±5,4 versus 22,3±8,1 mm, p<0,05). Observamos ainda uma subida significativa do strain longitudinal da AD (26,5±9,6% versus 35,3±10,5%, p<0,001). ConclusãoApós encerramento percutâneo de CIA ostium secundum, observou-se um aumento significativo do strain longitudinal global da AD." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1877 "Ancho" => 2500 "Tamanyo" => 411734 ] ] "descripcion" => array:1 [ "en" => "Right atrial longitudinal strain imaging." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ASD: atrial septal defect; BMI: body mass index; bpm: beats per min; DBP: diastolic blood pressure; HR: heart rate; SBP: systolic blood pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.6±8.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender, female/male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23/9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">123±15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69±9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR, bpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93±11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ASD diameter, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14±5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Device diameter, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.5±7.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Qp/Qs ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.6±0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI, kg/m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.89±0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1626446.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics and echocardiographic measurements in patients with atrial septal defect." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "LA: left atrial; LV: left ventricular; LVEDD: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic diameter; PASP: pulmonary artery systolic pressure; RA: right atrial; RV: right ventricular; RVEDD: right ventricular end-diastolic diameter; TAPSE: tricuspid annular plane systolic excursion." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-procedure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">One month post-procedure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEDD, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVESD, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58±3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">LA diameters, mm</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antero-posterior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medio-lateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apico-basal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">RA diameters, mm</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medio-lateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apico-basal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVEDD, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PASP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.4±16.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.3±12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSE, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.6±5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.3±8.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RA longitudinal strain, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.5±9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.3±10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1626448.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Effects of atrial septal defect closure on echocardiographic parameters." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ASD: atrial septal defect; LA: left atrial; LVEDD: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; PASP: pulmonary artery systolic pressure; RA: right atrial; RVEDD: right ventricular end-diastolic diameter; TAPSE: tricuspid annular plane systolic excursion." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Delta (post-ASD minus pre-ASD) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pearson's correlation coefficient (r) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVEDD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">-4.9±4.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">-0.573 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RA diameter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">-5.23±5.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">-0.154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEDD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">+2.19±4.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.061 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA diameter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">-2.25±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">-0.132 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.068 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">+5.13±3.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.119 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.047 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PASP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">-14.1±13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">-0.497 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">+4.7±6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.514 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.027 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1626447.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlations between right atrial longitudinal strain and other echocardiographic parameters in patients with atrial septal defect." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of congenital heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.I. 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Original Article

Assessment of right atrial function with speckle tracking echocardiography after percutaneous closure of an atrial septal defect

Avaliação da função auricular direita por ecocardiograma com speckle tracking após encerramento percutâneo de comunicação interauricular

Onder Ozturka,

Corresponding author

droozturk21@hotmail.com

Corresponding author.

, Unal Ozturkb, Sengul Ozturkc

a University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Cardiology, Diyarbakir, Turkey

b University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Neurology, Diyarbaki, Turkey

c University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Archives and Dicle University Agricultural Faculty, Department of Plant Protection,, Diyarbakir, Turkey

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Atrial septal defect &#40;ASD&#41; accounts for 25-30&#37; of congenital heart defects diagnosed during adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> Ostium secundum ASD is the most common type&#44; constituting 70&#37; of all ASDs and 6-10&#37; of all congenital heart defects&#46; Left atrial &#40;LA&#41; and right atrial &#40;RA&#41; diameters and volumes are increased in ASD patients due to volume overload&#46; ASDs cause a left-to-right shunt and chronic right chamber volume overload that can result in severe pulmonary hypertension and right heart failure&#46; Secundum ASDs are centrally located and generally bounded by the superior and inferior limbic bands&#44; which often makes these defects amenable to device closure&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the absence of fixed pulmonary hypertension&#44; percutaneous ASD closure is associated with improvements in right ventricular dimensions&#44; morphology and function and exercise physiology&#44; and reverse right ventricular &#40;RV&#41; remodeling&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> However&#44; such adaptations can be incomplete or delayed in adult patients&#44; and atrial changes post-ASD closure are poorly understood&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">New echocardiographic methods have been developed to quantify left and right ventricular function and are important for diagnostic and prognostic assessment in various cardiovascular diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">5&#44;6</span></a> A new echocardiographic technique&#44; two-dimensional &#40;2D&#41; speckle tracking echocardiography &#40;STE&#41;&#44; is capable of angle-independent tracking of myocardial deformation&#44; enabling non-invasive and quantitative assessment of global and regional myocardial function&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Myocardial STE measures tissue deformation within the myocardium expressed as a percentage change&#46; Myocardial tissue lengthening and shortening give positive and negative strain values&#44; respectively&#46; Strain rate measures the local rate of myocardial deformation per time unit&#46; The global strain or strain rate is calculated by computing deformation along the entire myocardial line length&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;9</span></a> This new echocardiographic method is frequently used to assess left ventricular &#40;LV&#41; myocardial function&#44; but has rarely been used to examine RA and RV myocardial function&#46; Myocardial strain and strain rate can be used to investigate RA myocardial function during each phase of the cardiac cycle&#46; Padeletti et al&#46; showed that RA speckle tracking analysis is significantly correlated with systolic pulmonary artery pressure and pulmonary arterial hypertension secondary to LV systolic dysfunction&#46; They also found that assessment of RA longitudinal strain can identify pulmonary artery hypertension in congestive heart failure patients&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The objective of the present study was to evaluate RA function by quantifying longitudinal RA strain in patients with chronic RV volume overload due to an ostium secundum ASD before and after percutaneous closure&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with secundum ASD admitted to our center for percutaneous closure between June 2013 and December 2015 were included in this prospective controlled study&#46; A total of 38 consecutive patients with secundum type ASD were investigated&#46; The clinical indication for ASD closure was a hemodynamically significant left-to-right shunt &#40;Qp&#47;Qs &#62;2&#46;0&#41; or echocardiographic signs of right heart dilation or shunt-related symptoms&#46; Patients with a stretched ASD larger than 36 mm&#44; those with inadequate atrial septal rims to permit stable device deployment&#44; those in whom the defect was close to the AV valves&#44; coronary sinus or vena cavae&#44; and those with sinus venosus or primum ASD&#44; pulmonary vascular resistance greater than eight Wood units despite 100&#37; oxygen&#44; other concomitant congenital heart disease&#44; valvular heart disease&#44; coronary artery disease&#44; LV systolic dysfunction&#44; atrial fibrillation&#44; or hypertension were excluded&#46; Six patients were not suitable for percutaneous ASD closure and so the study population consisted of 32 patients &#40;23 female&#44; nine male&#44; mean age 41&#177;13 years&#41; with secundum type ASD and in sinus rhythm who underwent successful percutaneous ASD closure&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study participants underwent clinical and echocardiographic assessment before and one month after percutaneous closure ASD&#46; The study was approved by the local ethics committee of our hospital&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Echocardiographic examination</span><p id="par0040" class="elsevierStylePara elsevierViewall">All patients underwent comprehensive transthoracic echocardiographic examinations at rest according to the American Society of Echocardiography guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> using a Philips EPIQ 7C ultrasound system &#40;Philips Healthcare&#44; Andover&#44; MA&#44; USA&#41; equipped with a multifrequency transducer &#40;3-8 MHz&#41; and tissue harmonic imaging capability&#46; A single-lead electrocardiogram was recorded continuously and 2D echocardiographic images of the right atrium and right ventricle were obtained in apical 4-chamber view at end-expiration&#46; Care was taken to capture the entire right atrium&#44; allowing for more reliable delineation of the atrial endocardial border&#46; The frame rate was set at between 40 and 80 frames per second&#46; At least three consecutive cardiac cycles of 2D echocardiographic images recorded in apical 4-chamber view were stored in order to select the images with the best quality for off-line speckle tracking analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Two-dimensional speckle tracking analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Two-dimensional strain and strain rate analysis is a reliable technique for tracking of myocardial movement and deformation&#46; Standard grayscale images are analyzed with a dedicated software package that focuses on specific speckle patterns and follows them on a frame-by-frame basis during a cardiac cycle&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> In contrast to Doppler-derived indices&#44; STE has the advantage of being angle-independent&#44; and is less affected by reverberations&#44; side lobes and dropout artifacts&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> STE is frequently used to assess LV function and in recent years has been used to quantify longitudinal myocardial LA and RA deformation dynamics&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Speckle tracking analysis was performed by a single experienced and independent investigator &#40;OO&#41; who was blinded to the clinical data&#44; using commercially available semiautomated 2D wall motion tracking software &#40;Philips Healthcare Systems&#41;&#46; To assess RA myocardial function&#44; the RA endocardium was manually traced when the right atrium was at its maximum volume&#44; just before tricuspid valve opening&#44; as identified in apical 4-chamber view&#46; The RA basal septal&#44; basal lateral and apical borders were manually traced&#44; followed by automatic tracing of the endocardial and epicardial borders&#44; thus delineating a region of interest composed of six segments&#46; After analysis of segmental tracking quality and manual adjustment of the region of interest&#44; longitudinal strain curves were generated by the software for each atrial segment&#46; A cine loop preview feature enabled visual confirmation that the internal line followed the movements of the RA endocardium throughout the cardiac cycle&#46; If tracking of the RA endocardium was unsatisfactory&#44; manual adjustments of the region of interest size were performed to ensure optimal tracking &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; RA longitudinal strain was measured in six segments of the atrium&#46; As previously described&#44; peak RA longitudinal strain at the end of the RA reservoir phase was calculated by averaging the values for all RA segments to yield global RA longitudinal strain&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;12</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Percutaneous atrial septal defect closure procedure</span><p id="par0055" class="elsevierStylePara elsevierViewall">Percutaneous ASD closure was performed under general anesthesia utilizing fluoroscopic and multiplane transesophageal echocardiographic &#40;TEE&#41; guidance&#46; Closure was achieved using Figulla Flex II ASD devices &#40;Occlutech GmbH&#44; Jena&#44; Germany&#41;&#46; The larger diameters of the ASD were measured at different angles of 2D and three-dimensional TEE and device size was determined by adding 2-4 mm to the larger ASD diameter&#46; In addition&#44; the distance to the defect was required to be at least 5 mm from the mitral valve&#44; right upper pulmonary vein&#44; coronary sinus&#44; tricuspid valve&#44; inferior vena cava&#44; and superior vena cava&#46; In the case of deficient aortic rim &#40;&#60;5 mm&#41;&#44; percutaneous closure was performed if the other rims had sufficient length&#46; Balloon measurements were not performed routinely&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12&#44;13</span></a> Post-interventional treatment included 100 mg&#47;day aspirin and 75 mg&#47;day clopidogrel for six months&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with the SPSS statistical package&#44; version 12&#46;0 &#40;SPSS Inc&#46;&#41;&#46; Continuous variables were expressed as mean &#177; SD and categorical variables were expressed as percentages&#46; Intra-observer variability was calculated as the absolute difference between two measurements in percentage of their mean&#46; The Student&#39;s t test and the chi-square test were used for comparison of data&#44; as appropriate&#46; Differences between baseline and follow-up were analyzed by the paired sample t test&#46; Pearson correlation analysis was used to determine the relationship between RA longitudinal strain and other echocardiographic parameters&#46; A p value &#60;0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Baseline demographic characteristics and procedure-related clinical parameters of the study population are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The mean native secundum ASD diameter on color Doppler echocardiographic assessment was 14&#177;5 mm &#40;10-22 mm&#41; and the mean diameter of the closure devices used was 18&#46;5&#177;7&#46;5 mm &#40;14-28 mm&#41;&#46; Percutaneous closure was performed successfully in all 32 patients&#46; There was no residual ASD in any of the patients on echocardiographic assessment at one month after the procedure&#46; The echocardiographic measurements are given in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; RV end-diastolic diameters were significantly increased but decreased significantly after ASD closure &#40;43&#177;5 vs&#46; 38&#177;4 mm&#44; p&#60;0&#46;05&#41;&#46; LA diameters &#40;40&#177;8 vs&#46; 37&#177;6 mm&#44; p&#60;0&#46;05&#41; decreased significantly after the intervention&#44; whereas LV end-diastolic diameters &#40;45&#177;5 vs&#46; 46&#177;4 mm&#44; NS&#41; remained unchanged&#46; Tricuspid annular plane systolic excursion &#40;TAPSE&#41; increased significantly &#40;17&#46;6&#177;5&#46;4 vs&#46; 22&#46;3&#177;8&#46;1 mm&#44; p&#60;0&#46;05&#41;&#46; After closure of the defect&#44; a significant increase was observed in longitudinal RA strain &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Intra-observer variability for RA longitudinal strain was 3&#46;2&#43;1&#46;6&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Correlation analysis was performed between post-ASD and pre-ASD parameters&#46; The delta value was calculated as post-ASD parameter minus pre-ASD parameter&#46; The analysis showed negative correlations between delta RA longitudinal strain and delta RV diameter&#44; delta RA diameter and delta pulmonary artery systolic pressure &#40;PASP&#41;&#46; Also&#44; a positive correlation was found between delta RA longitudinal strain and delta TAPSE&#46; However&#44; there was no correlation between delta RA longitudinal strain and delta LVEF&#44; delta LV diameter or delta LA diameter &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The right atrium has multiple important roles during the cardiac cycle&#58; it functions as a reservoir for systemic venous return when the tricuspid valve is closed&#44; provides a passive conduit for blood flow during early diastole when the tricuspid valve opens&#44; and actively expels blood during late diastole with atrial contraction&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> The right atrium has an unusual geometry and thin walls&#46; Assessment of atrial dimensions and volume using 2D echocardiographic parameters has limitations&#46; Measurement of atrial dimensions with M-mode and 2D echocardiography assumes the atria have an elliptical geometry&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> but this is clearly not completely true&#44; and the variable and non-uniform geometry of the atria leads to significant differences in the measurement of atrial volumes using the biplane area-length method and biplane modified Simpson&#39;s rule&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> Anatomical and functional assessment of the RA is therefore difficult&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">16&#8211;18</span></a> In previous studies&#44; 2D transthoracic echocardiographic measurements in patients with ASD demonstrated enlarged right atrium&#44; right ventricle&#44; and pulmonary arteries&#46; These usually correlate with the magnitude of the left-to-right shunt&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> In the past decade&#44; the novel echocardiographic technique of strain imaging has been used to make more accurate assessments of myocardial function&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> STE has been used in a wide range of cardiovascular conditions&#44; including hypertension&#44; heart failure and myocardial infarction&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21&#44;22</span></a> Conventional ways of determining systolic function rely on visual assessment of wall motion and changes in volume&#46; However&#44; STE measures actual tissue deformation within the myocardium&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">One of the new applications of STE is in assessment of RA myocardial function&#46; The RA reservoir phase is a dynamic phase of the cardiac cycle&#46; RA deformation is dependent on preload and afterload&#44; which affect the right ventricle and consequently influence the right atrium&#46; We therefore assessed RA myocardial function in patients with percutaneous ASD closure by focusing on the reservoir phase&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Two-dimensional STE assessment of RA myocardial function is feasible throughout the cardiac cycle&#46; Peak RA longitudinal strain determines the reservoir phase&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> Padeletti et al&#46; reported that RA STE significantly correlated with pulmonary pressure&#46; They also found that RA assessment with STE can predict pulmonary artery hypertension in heart failure patients&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> We demonstrated that peak RA longitudinal strain increased significantly after percutaneous closure of secundum ASD&#46; Our study is the first to assess the effect of percutaneous ASD closure on RA function with STE&#46; Sakata et al&#46; reported that RA longitudinal strain was useful for noninvasive assessment of RA dysfunction in patients with pulmonary artery hypertension&#46; They also found that peak global RA longitudinal strain was correlated with cardiac index&#46; Peak global RA longitudinal strain can be thus useful for the assessment of RA overload and dysfunction in pulmonary artery hypertension&#46; This study showed an inverse correlation between PASP and peak global RA longitudinal strain&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In our study&#44; there was improvement in multiple echocardiographic parameters&#44; including RV end-diastolic diameter&#44; RA diameter&#44; RV&#47;LV end-diastolic diameter ratio&#44; LA diameter and PASP at one month post-procedure&#46; LV end-diastolic diameter and LV end-systolic diameter remained unchanged in the first month post-procedure&#44; while LVEF and TAPSE were significantly increased&#46; In this study&#44; there was a positive correlation between delta RA longitudinal strain and delta LVEF and TAPSE and a negative correlation between delta RA longitudinal strain and delta RV myocardial performance index&#44; RV diameter&#44; RA diameter and PASP&#46; Our finding of decreased RA and LA dimensions after percutaneous ASD closure is in agreement with similar reports in previous studies&#46; For example&#44; Akula et al&#46; found a significant decrease in RV volumes in the first month after ASD closure that continued up to six months&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> and Veldtman et al&#46; found that right heart morphology undergoes rapid improvement within one month of percutaneous ASD closure&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> Atashband et al&#46; showed that percutaneous ASD closure in adults is effective&#44; leading to reverse remodeling and better functional capacity&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> while Thil&#233;n et al&#46; found that cardiac remodeling after ASD closure in the adult is common and is generally completed within the first half year after closure&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Study limitations</span><p id="par0095" class="elsevierStylePara elsevierViewall">STE can be used for myocardial assessment in all dimensions &#40;longitudinal&#44; radial&#44; and circumferential&#41;&#46; In our study&#44; we measured RA longitudinal strain only&#46; Only one cardiac cycle was studied&#44; and so respiratory variations may be a source of sample error&#46; The software used for STE analysis was originally designed for the left ventricle&#44; but in the present study it was applied to the right atrium&#46; Defects in the atrial septum and the presence of an occlusion device may have affected RA longitudinal strain values&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Volume overload is associated with decreased strain values&#44; which return to normal when the volume overload is abolished&#46; In this study&#44; RA longitudinal strain measured by 2D-STE was useful to assess the effect of percutaneous ASD closure on RA dysfunction in the reservoir phase&#46; STE can be considered a feasible and reproducible noninvasive technique for the assessment of RA longitudinal deformation dynamics in patients with ASD&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Speckle tracking echocardiography &#40;STE&#41; for two-dimensional &#40;2D&#41; strain analysis is a new tool to assess myocardial function&#46; The aim of this study was to assess right atrial &#40;RA&#41; function using STE in patients with an atrial septal defect &#40;ASD&#41; before and one month after percutaneous closure&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We prospectively examined 32 consecutive patients &#40;nine male&#44; 23 female&#41; who underwent percutaneous transcatheter closure of a secundum ASD between June 2013 and December 2015&#46; Echocardiography was performed on admission&#44; prior to cardiac catheterization and then one month after ASD closure&#46; Peak global RA longitudinal strain was analyzed by 2D-STE&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients&#8217; mean age was 34&#46;6&#177;8&#46;2 years&#46; The mean diameter of the occlusive devices was 18&#46;5&#177;7&#46;5 mm&#46; Right ventricular &#40;RV&#41; end-diastolic diameters were significantly increased but decreased significantly after ASD closure &#40;43&#177;5 vs&#46; 38&#177;4 mm&#44; p&#60;0&#46;05&#41;&#46; Left atrial &#40;LA&#41; diameters &#40;40&#177;8 vs&#46; 37&#177;6 mm&#44; p&#60;0&#46;05&#41; decreased significantly after the intervention&#44; whereas left ventricular &#40;LV&#41; end-diastolic diameters &#40;45&#177;5 vs&#46; 46&#177;4 mm&#44; NS&#41; remained unchanged&#46; Tricuspid annular plane systolic excursion increased significantly &#40;17&#46;6&#177;5&#46;4 vs&#46; 22&#46;3&#177;8&#46;1 mm&#44; p&#60;0&#46;05&#41;&#46; After closure of the defect&#44; a significant increase was observed in longitudinal RA strain &#40;26&#46;5&#177;9&#46;6&#37; vs&#46; 35&#46;3&#177;10&#46;5&#37;&#44; p&#60;0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">After percutaneous transcatheter closure of a secundum ASD&#44; there was an increase in RA longitudinal strain&#46; 2D-STE strain analysis appears to be helpful for the assessment of RA function and of response to correction of volume overload after percutaneous transcatheter closure of a secundum ASD&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O <span class="elsevierStyleItalic">speckle tracking</span> por ecocardiograma &#40;STE&#41; ou a avalia&#231;&#227;o do <span class="elsevierStyleItalic">strain</span> em 2 D s&#227;o novas ferramentas para a avalia&#231;&#227;o da fun&#231;&#227;o mioc&#225;rdica&#46; O objetivo deste estudo foi avaliar a fun&#231;&#227;o da aur&#237;cula direita &#40;AD&#41; com o uso de STE em doentes com comunica&#231;&#227;o interauricular antes e um m&#234;s ap&#243;s o encerramento percut&#226;neo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Avaliamos prospetivamente 32 doentes consecutivos &#40;nove homens&#44; 23 mulheres&#41; submetidos a encerramento percut&#226;neo de comunica&#231;&#227;o interauricular &#40;CIA&#41; do tipo <span class="elsevierStyleItalic">ostium secundum</span>&#44; entre junho de 2013 e dezembro de 2015&#46; O ecocardiograma foi feito previamente ao procedimento e um m&#234;s ap&#243;s o encerramento da CIA&#46; Foi avaliado o <span class="elsevierStyleItalic">strain</span> longitudinal global da AD &#40;RALS&#41; por 2D-STE&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A idade m&#233;dia dos doentes foi de 34&#44;6&#177;8&#44;2 anos&#46; O di&#226;metro m&#233;dio dos dispositivos empregados foi de 18&#44;5&#177;7&#44;5 mm&#46; Os di&#226;metros telediast&#243;licos do ventr&#237;culo direito &#40;VD&#41; eram significativamente maiores e diminu&#237;ram ap&#243;s encerramento da CIA &#40;43&#177;5 <span class="elsevierStyleItalic">versus</span> 38&#177;4 mm&#44; p&#60;0&#44;05&#41;&#46; O di&#226;metro da aur&#237;cula esquerda &#40;AE&#41; diminuiu significativamente ap&#243;s a interven&#231;&#227;o &#40;40&#177;8 <span class="elsevierStyleItalic">versus</span> 37&#177;6 mm&#44; p&#60;0&#44;05&#41;&#44; enquanto que o di&#226;metro telediast&#243;lico do ventr&#237;culo esquerdo permaneceu igual &#40;45&#177;5 <span class="elsevierStyleItalic">versus</span> 46&#177;4 mm&#44; NS&#41;&#46; O TAPSE aumentou significativamente &#40;17&#44;6&#177;5&#44;4 <span class="elsevierStyleItalic">versus</span> 22&#44;3&#177;8&#44;1 mm&#44; p&#60;0&#44;05&#41;&#46; Observamos ainda uma subida significativa do <span class="elsevierStyleItalic">strain</span> longitudinal da AD &#40;26&#44;5&#177;9&#44;6&#37; <span class="elsevierStyleItalic">versus</span> 35&#44;3&#177;10&#44;5&#37;&#44; p&#60;0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ap&#243;s encerramento percut&#226;neo de CIA <span class="elsevierStyleItalic">ostium secundum</span>&#44; observou-se um aumento significativo do <span class="elsevierStyleItalic">strain</span> longitudinal global da AD&#46;</p></span>"
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          1 => array:2 [
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          3 => array:2 [
            "identificador" => "abst0040"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Right atrial longitudinal strain imaging&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; atrial septal defect&#59; BMI&#58; body mass index&#59; bpm&#58; beats per min&#59; DBP&#58; diastolic blood pressure&#59; HR&#58; heart rate&#59; SBP&#58; systolic blood pressure&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#46;6&#177;8&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#177;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Device diameter&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;5&#177;7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Qp&#47;Qs ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;6&#177;0&#46;7&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">LA&#58; left atrial&#59; LV&#58; left ventricular&#59; LVEDD&#58; left ventricular end-diastolic diameter&#59; LVEF&#58; left ventricular ejection fraction&#59; LVESD&#58; left ventricular end-systolic diameter&#59; PASP&#58; pulmonary artery systolic pressure&#59; RA&#58; right atrial&#59; RV&#58; right ventricular&#59; RVEDD&#58; right ventricular end-diastolic diameter&#59; TAPSE&#58; tricuspid annular plane systolic excursion&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">One month post-procedure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LVEDD&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#177;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LVEF&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#177;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">LA diameters&#44; mm</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antero-posterior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#177;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medio-lateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#177;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Apico-basal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">RA diameters&#44; mm</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medio-lateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#177;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Apico-basal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#177;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#177;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">RVEDD&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#177;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;4&#177;16&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;3&#177;12&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">TAPSE&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;6&#177;5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;3&#177;8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">RA longitudinal strain&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;5&#177;9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;3&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Effects of atrial septal defect closure on echocardiographic parameters&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; atrial septal defect&#59; LA&#58; left atrial&#59; LVEDD&#58; left ventricular end-diastolic diameter&#59; LVEF&#58; left ventricular ejection fraction&#59; PASP&#58; pulmonary artery systolic pressure&#59; RA&#58; right atrial&#59; RVEDD&#58; right ventricular end-diastolic diameter&#59; TAPSE&#58; tricuspid annular plane systolic excursion&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;061&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-2&#46;25&#177;4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-0&#46;132&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;5&#46;13&#177;3&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;047&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-14&#46;1&#177;13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-0&#46;497&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TAPSE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;4&#46;7&#177;6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;514&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Correlations between right atrial longitudinal strain and other echocardiographic parameters in patients with atrial septal defect&#46;</p>"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2017.06.010

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	5	11
2024 October	29	29	58
2024 September	48	31	79
2024 August	54	30	84
2024 July	31	26	57
2024 June	38	21	59
2024 May	35	27	62
2024 April	34	33	67
2024 March	33	24	57
2024 February	36	23	59
2024 January	19	22	41
2023 December	29	31	60
2023 November	31	27	58
2023 October	28	15	43
2023 September	24	21	45
2023 August	38	14	52
2023 July	28	7	35
2023 June	30	18	48
2023 May	52	26	78
2023 April	37	3	40
2023 March	70	22	92
2023 February	52	24	76
2023 January	27	21	48
2022 December	70	18	88
2022 November	83	28	111
2022 October	84	35	119
2022 September	73	46	119
2022 August	71	29	100
2022 July	74	50	124
2022 June	39	37	76
2022 May	29	41	70
2022 April	46	42	88
2022 March	45	50	95
2022 February	43	34	77
2022 January	35	36	71
2021 December	29	36	65
2021 November	37	40	77
2021 October	63	47	110
2021 September	33	31	64
2021 August	51	30	81
2021 July	25	24	49
2021 June	28	25	53
2021 May	47	43	90
2021 April	99	46	145
2021 March	74	27	101
2021 February	78	25	103
2021 January	46	13	59
2020 December	57	14	71
2020 November	33	14	47
2020 October	26	18	44
2020 September	51	17	68
2020 August	29	10	39
2020 July	50	11	61
2020 June	49	13	62
2020 May	54	12	66
2020 April	51	16	67
2020 March	70	11	81
2020 February	48	17	65
2020 January	40	9	49
2019 December	38	2	40
2019 November	33	8	41
2019 October	28	6	34
2019 September	34	14	48
2019 August	36	9	45
2019 July	31	11	42
2019 June	40	13	53
2019 May	44	12	56
2019 April	31	19	50
2019 March	117	13	130
2019 February	134	11	145
2019 January	114	10	124
2018 December	114	13	127
2018 November	85	24	109
2018 October	36	12	48
2018 September	24	13	37
2018 August	27	5	32
2018 July	17	2	19
2018 June	25	5	30
2018 May	24	3	27
2018 April	23	5	28
2018 March	69	12	81
2018 February	46	13	59
2018 January	35	14	49
2017 December	22	9	31

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