Distinct remodeling patterns after ASD and PFO closure: a comparative atrial strain and myocardial work analysis - initial results

Abstract Background Atrial septal defect (ASD) and patent foramen ovale (PFO) are prevalent forms of interatrial communications associated with paradoxical embolism and right heart volume overload. Transcatheter closure is a guideline-recommended treatment strategy for selected patients. Advances in echocardiographic imaging, such as myocardial work (MW) and atrial strain analysis, offer enhanced insight into cardiac performance beyond conventional volumetric measures. Purpose This study aimed to assess longitudinal changes in left ventricular (LV) MW and atrial function in patients undergoing percutaneous closure of ASD or PFO, and to compare these parameters between the groups at baseline, 1 month, and 6 months post-procedure. Methods This observational study included 34 patients (27 with PFO and 7 with ASD) undergoing transcatheter closure of an interatrial shunt. Transthoracic echocardiography was performed before the procedure, and at 1 and 6 months of follow-up. Left atrial (LA) strain was assessed using speckle-tracking echocardiography, including reservoir (LASr), conduit (LAScd), and contractile (LASct) strain, with additional biatrial (LA+RA) analysis. LV MW indices, including global longitudinal strain (GLS) and global work index (GWI), were calculated using non-invasive pressure–strain loop methodology. To ensure measurement accuracy, the interatrial septum, containing occluder material post-implantation in all patients, was excluded from the region of interest during atrial strain analysis. Results In the ASD group, a significant reduction in right ventricular (RV) diameter was observed at 1 month (49.4 ± 5.2mm to 42.3 ± 5.9mm; p