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Adults with small, unrepaired atrial septal defects have reduced cardiac index during exercise

Published online by Cambridge University Press:  05 December 2022

Marie Maagaard*
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Nicolai Boutrup
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
Sebastian Udholm
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
Mathias Ahlstrup
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
Jens Erik Nielsen-Kudsk
Affiliation:
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Steffen Ringgaard
Affiliation:
The MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
Vibeke Hjortdal
Affiliation:
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
*
Author for correspondence: M. Maagaard, MD, PhD, Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. Tel: +45 7845 3080; Fax: +45 7845 3079. E-mail: maagaard@clin.au.dk

Abstract

Objectives:

Small, unrepaired atrial septal defects are considered a benign lesion with good prognosis. Recently, clinical and register-based studies discovered increased long-term mortality and morbidity. The nature of these findings is not fully understood. Therefore, MRI was performed to evaluate cardiac function at rest and during exercise.

Methods:

Adults with open or spontaneously closed atrial septal defects and healthy, matched controls underwent MRI for evaluation of cardiac chamber volume. Quantitative flow scans measured blood flow in the ascending aorta and the proximal pulmonary artery at rest and during increasing supine exercise.

Results:

In total, 15 open defects (39 ± 11 years) and 15 matched controls (38 ± 12 years) were included, along with 20 spontaneously closed (36 ± 13 years) and 20 controls (36 ± 11 years). Cardiac chamber volumes and flow measurements at rest were comparable between groups, as were heart rates and workloads during exercise. At maximal exercise, open defects reached 31% lower cardiac index and had 38% higher retrograde flow in the pulmonary artery than their controls, p < 0.01. Shunt ratio remained unchanged during exercise, 1.2 ± 0.2. Closed defects reached 18% lower cardiac index, p = 0.02, with comparable pulmonary retrograde flow. Maximal cardiac index was inversely correlated with increasing age for patients only.

Conclusion:

Adults with a small, open or spontaneously closed atrial septal defects exhibit markedly lower exercise capacity compared with healthy peers. Moreover, open defects exhibit higher retrograde flows with increasing exercise. Finally, increasing age is related to poorer results in patients but not healthy controls. Longitudinal studies are necessary in order to determine potential accelerated worsening of physical capacity along with age-related changes in patients.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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