Cardiovasc Imaging Asia.  2024 Apr;8(2):32-38. 10.22468/cvia.2023.00108.

Time-to-Notch Doppler Right Ventricular Outflow Tract: Non-Invasive Parameter for Predicting Pulmonary Vascular Disease in Adults With Ostium Secundum Atrial Septal Defect

• Lilyasari O
• AP MA
• Prakoso R
• Mangkuanom AS
• Sembiring AA
• Proklamartina NC
• Soesanto AM

• KMID: 2555712
• DOI: http://doi.org/10.22468/cvia.2023.00108

Abstract

Objective
Uncorrected atrial septal defect (ASD) leads to pulmonary vascular disease (PVD) later in adulthood. Attempts to close the defect have proven to be detrimental in the presence of PVD. Although right heart catheterization (RHC) is the gold standard for PVD, it remains an invasive approach with complications. Notch characteristics on the right ventricular outflow tract (RVOT) Doppler correlate well with parameters of pulmonary hypertension. Therefore, this study evaluated whether time-to-notch RVOT Doppler could detect PVD in adults with ASD.
Materials and Methods
Between March 2019 and June 2020, we consecutively sampled adult patients with ostium secundum ASD. Time-to-notch was examined by transthoracic echocardiogram within 24 hours of RHC. A vasoreactivity test was performed when the ratio of resistance arterial pulmonary to systemic (PVR:SVR) was ≥0.33. PVD was diagnosed if the final resistance ratio was ≥0.33.
Results
We analysed 89 subjects with ASD. A vasoreactivity test was performed in 54 patients with pure oxygen, and 37% (n=24) had PVD. The majority of subjects in this study were women (85%) with a median age of 38 years. The time-to-notch RVOT Doppler was significantly shorter in subjects with PVD compared to those without (132±17 ms vs. 177±29 ms, p<0.001). The area under the curve was 0.923 for time-to-notch to predict PVR:SVR ≥0.33. A cutoff point of <147.5 ms was able to detect PVD (sensitivity 88%, specificity 87%, positive predictive value 72%, negative predictive value 95%, positive likelihood ratio [LR] 7.11, and negative LR 0.14).
Conclusion
Time-to-notch RVOT Doppler has substantial predictive value in detecting PVD in secundum ASD-pulmonary arterial hypertension populations.

Keyword

Pulmonary vascular disease; Atrial septal defect; Pulmonary hypertension; Time-to-notch