Longitudinal changes in right ventricular-pulmonary arterial coupling after defect closure in adult congenital heart disease: The LET SHINE registry

Abstrak

Background: Right ventricular-pulmonary arterial (RV-PA) coupling reflects right ventricular adaptation to afterload and can be estimated non-invasively by echocardiography. Whether coupling recovery after defect closure in adult left-to-right shunt congenital heart disease (CHD) differs by lesion location, and whether baseline coupling predicts persistent pulmonary hypertension (PH), remains poorly defined in Southeast Asian populations.Objective: To evaluate longitudinal change in echocardiographic RV-PA coupling after defect closure, compare trajectories between pre-tricuspid (atrial septal defect) and post-tricuspid (ventricular septal defect and patent ductus arteriosus) lesions, and assess baseline coupling as a predictor of persistent PH at 12 months.Methods: This retrospective cohort study included 93 adults with left-to-right shunt CHD from the LET SHINE Registry who underwent defect closure and echocardiography at baseline (T0), 3 months (T1), and 12 months (T2), right heart catheterization is performed before the defect was closed. Six RV-PA coupling ratios (TAPSE/sPAP, TAPSE/PVAcT, TAPSE/TRV max, FAC/sPAP, FAC/PVAcT, FAC/TRV max) were compared across time, between lesion groups (Linear Mixed Model), and by ROC analysis for persistent PH (echocardiographic sPAP ≥35 mmHg at T2).Result: All six ratios improved significantly from T0 to T1 (p<0.001) and remained stable to T2. Pre-tricuspid lesions had lower baseline coupling but greater, more sustained improvement (group×time interaction p<0.001 for all ratios). Persistent PH occurred in 23/93 patients (24.7%). Baseline TAPSE/sPAP and FAC/sPAP discriminated persistent PH (AUC 0.780 and 0.786) comparably to invasive mPAP and PVR (AUC 0.805 and 0.800). Conclusion: RV-PA coupling improves substantially within 3 months after defect closure (all ratios, p<0,001), reflecting an acute fall in RV loading once the shunt is closed rather than slow structural remodelling, but follows a lesion-specific trajectory (group×time interaction p≤0,012; greater 12-month gains in pre-tricuspid than post-tricuspid lesions, Cohen's d 0,53-0,77), consistent with the differing reversibility of volume-overload (ASD) versus combined volume-pressure overload (VSD/PDA) remodelling. Baseline coupling ratios offer non-invasive predictive value for persistent PH (TAPSE/sPAP and FAC/sPAP AUC 0,780 dan 0,786) comparable to invasive hemodynamics (mPAP and PVR AUC 0,805 dan 0,800), because these ratios capture RV function relative to its afterload rather than contractility alone.

Kata kunci

• Congenital Heart Disease
• Pulmonary Hypertension
• Retrospective Studies
• Ventricular-Pulmonary Arterial Coupling
• Closure Defect