Correlation of Pulmonary to Systemic Flow Ratio and Adiponection Level in Grown-Up Uncorrected Atrial Septal Defect Patients
Author : K. Mawaris, W. Himawan, D.W. Anggrahini, A.B. Hartopo, L. Krisdinarti
Upload Date : 19-04-2018
Background. Atrial septal defect (ASD) has become the most common congenital heart defect found in grown-adult. Uncorrected ASD in adult will cause volume overload and inducing endothelial injury in pulmonic circulation. Matrix degradation and growth factor then induced smooth muscle cell hypertrophy and proliferation. Previous studies showed that adiponectin, poduced by adipocytes, could supress vascular remodelling by its direct effect on pulmonary smooth muscle cell. Changes in pulmonary to systemic flow ratio (FR), pulmonary vascular tone, increased inflammation, may have link with adiponectin levels. This study aimed to assess correlation of FR and adiponectin level in grown-up uncorrected ASD patients.
Methods. A cross-sectional study was conducted in grown-up, uncorrected secundum ASD registered in ASD Registry of dr Sardjito Hospital From January 2015 to November 2015. Subjects with congenital heart defects other than ASD were excluded. The clinical features, body mass index (BMI), and transcutaneous oxygen saturation were characterized. Echocardiographic features (defect diameter, shunt direction, right ventricle function) and FR were measured. An increased FR was defined as pulmonary to systemic flow (Qp/Qs) >1.5. Venous blood sampling were drawn and plasma adiponectin level were measured using ELISA technique.
Result. In 87 grown-up, uncorrected secundum ASD patients, median age was 33 years old, female (n=74), median BMI was 17 kg/m2, median transcutaneus oxygen saturation was 97%. Echocardiographic features showed mean defect diameter was 2.82 cm, median tricuspid anular plane systolic excursion (TAPSE) was 24 mm, and 23% have right to left shunt. Median adiponectin plasma level was 22 μg/mL. Amongst these subjects, 65 patients have FR >1.5 (mean adiponectin level=28.3 μg/mL) and 22 of them have FR < 1.5 (mean 24.2 μg/mL). No significant correlation was found between Flow Ratio and Adiponectin level (p = 0.11)
Conclusion. Flow Ratio was not statistically significant correlates with adiponectin levels in grown-up, uncorrected ASD patients.
KEYWORDS : Congenital heart defect; atrial septal defect; adiponectin levels; Flow ratio.