Pulmonary Doppler Notch Pattern in Relation with Pulmonary Vascular Resistance Index in Patients with Atrial Septal Defect

  • Nurnajmia Curie Proklamartina Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita
  • Radityo Prakoso Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita
  • Oktavia Lilyasari Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita
  • Rina Ariani Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita
  • Sisca Natalia Siagian Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita
  • Amiliana Mardiani Soesanto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita http://orcid.org/0000-0001-7898-4570
Keywords: atrial septal defect, Doppler echocardiography, notch, notch ratio, pulmonary vascular resistance

Abstract

Background: Atrial septal defect (ASD) potentially causes pulmonary hypertension (PH) and increased pulmonary vascular resistance (PVR). In previous studies, pulmonary Doppler notch was evident in patients with high PVR. There was a distinct notch pattern in different types of PH. This study aims to examine whether echocardiographic notch pattern could estimate PVR in secundum ASD patients.

Methods: Cross sectional study was conducted in secundum ASD patients ≥18 years old who underwent clinically indicated right heart catheterization. Association of notch presence and PVR index (PVRi) and correlation of notch ratio (NR), a parameter of notch location, and PVRi were analyzed. The best cut off of NR value was obtained using the receiver operating characteristics curve.

Results: Among 60 patients, the notch was present in 50 patients (83%) and significantly associated with PVRi ≥6 WU.m2 (p<0.0001). Notch ratio and PVRi had a moderate negative correlation (r=-0.410, p=0.003). Receiver operating characteristics curve with area under curve 0.709 showed that cutoff NR value of 1.635 was a good discriminator for PVRi ≥6 WU.m2, with 70% sensitivity, 70% specificity, 56.8% positive predictive value, and 14.9% negative predictive value. Patients were then classified into three groups of notch pattern based on its presence and location, which was significantly associated with PVRi (p<0.0001).

Conclusions: Pulmonary Doppler notch pattern is associated with PVRi in secundum ASD patients. This may be used clinically to estimate PVR to aid patient selection for further invasive investigation.

 

Keywords: atrial septal defect, Doppler echocardiography, notch, notch ratio, pulmonary vascular resistance

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Published
2021-03-07
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How to Cite
Proklamartina, N., Prakoso, R., Lilyasari, O., Ariani, R., Siagian, S., & Soesanto, A. (2021). Pulmonary Doppler Notch Pattern in Relation with Pulmonary Vascular Resistance Index in Patients with Atrial Septal Defect. Indonesian Journal of Cardiology, 41(3). https://doi.org/10.30701/ijc.1053