Headache and Left Ventricular Efficiency After Transcatheter Closure of Atrial Septal Defect

Ryohei Matsuoka, Jun Muneuchi, Yusaku Nagatomo, Yuichiro Sugitani, Hiroki Ezaki, Hirohito Doi, Mamie Watanabe

Research output: Contribution to journalArticlepeer-review

Abstract

Objective/Background: This study aimed to clarify the relationship between migraine-like headache and ventriculo-arterial coupling after transcatheter closure of the atrial septal defect in children. We hypothesized that migraine headache after defect closure would be related to an abnormal hemodynamic response against an increased left ventricular filling. Design: A retrospective cohort study. Methods: We calculated the end-ventricular systolic elastance (Ees), effective arterial elastance (Ea), and ventricular energy efficiency approximated based on echocardiography before and after defect closure, and compared these parameters between the subjects with and without headache after defect closure. Results: A total of 167 subjects were studied. Age at the procedure, defect diameter, and pulmonary to systemic blood flow ratio were 11 (9-17) years, 12.8 (9.2-16.0) mm, and 1.8 (1.6-2.3), respectively. We identified 47 (28%) subjects with migraine headache after defect closure. Although there was no significant difference in the Ees, Ea, and ventricular energy efficiency before defect closure between the groups, the Ees (4.0 [3.4-4.9] vs 4.8 [3.7-6.1], P =.014) and ventricular energy efficiency (0.79 [0.76-0.82] vs 0.83 [0.79-0.85], P =.001) after defect closure in subjects with headache were significantly lower than those in subjects without headache. Migraine headache after defect closure was significantly associated with age (odds ratio: 0.97, 95% confidential interval: 0.94-1.00, P =.036) and a decrease in the ventricular energy efficiency after defect closure (odds ratio: 6.42, 95% confidential interval: 2.76-14.90, P <.001). Conclusion: A loss of ventricular energy efficiency was common in pediatric subjects with migraine-like headache after transcatheter closure of the atrial septal defect, which suggested that the left ventricular function maladaptation was related to headache development after defect closure. We advocate that an impaired ventriculo-arterial coupling may be one of the mechanisms for developing attacks in not only this population but also in other patients with migraine.

Original languageEnglish
Pages (from-to)2421-2430
Number of pages10
JournalHeadache
Volume60
Issue number10
DOIs
Publication statusPublished - Nov 1 2020

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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