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Headache and Left Ventricular Efficiency After Transcatheter Closure of Atrial Septal Defect
Author(s) -
Matsuoka Ryohei,
Muneuchi Jun,
Nagatomo Yusaku,
Sugitani Yuichiro,
Ezaki Hiroki,
Doi Hirohito,
Watanabe Mamie
Publication year - 2020
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13990
Subject(s) - medicine , migraine , cardiology , odds ratio , retrospective cohort study , hemodynamics , anesthesia
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.