Changes And Clinical Significance Of Serum HDL-C In Adult Patients With Atrial Septal Defect And Pulmonary Hypertension

Objective: The changes and clinical significance of serum high-density lipoprotein cholesterol(HDL-C)was investigated in adult patients with atrial septal defect and pulmonary hypertension(ASD-PH).Methods: A total of 129 adult patients with secundum ASD hospitalized in the First Affiliated Hospital of Guangxi Medical University from 2016 to 2019 were included.According to the level of mean pulmonary arterial pressure(mPAP)and pulmonary vascular resistance(PVR)measured by right heart catheterization,the patients based on different stages of adult ASD-PH,were divided into ASD-I group(mPAP < 25 mm Hg and PVR < 3WU,71 cases),ASD-II group(mPAP between 25 mm Hg and 40 mm Hg,PVR<3WU,31 cases)and ASD-III group(mPAP>40mm Hg and PVR≥3WU,27 cases).Thirty-five normal subjects were collected as the control group.The basic information,concomitant diseases,medication,blood lipid,right heart catheterization parameters and other relevant clinical data of patients were retrospectively collected,and the changes of serum HDL-C and its influencing factors in each group were compared and analyzed.Results: 1.15.5% of adult patients with secundum ASD had other diseases and 21% of ASD patients had moderate to severe pulmonary arterial hypertension(PAH).2.In ASD-I group and ASD-II group,ASD-III group:(1)mPAP was 17.48±3.50 mm Hg,30.19±4.11 mm Hg and 54.11±9.96 mm Hg,respectively,with significant differences among the three groups(all P<0.05);(2)Pp/Ps was 0.30±0.16,0.40±0.07 and 0.80±0.21,respectively,with significant differences among the three groups(all P<0.05);(3)Qp/Qs was 2.28±0.92,2.77±1.36 and 1.82±0.75,respectively,of which ASD-III group was significantly lower than ASD-I and ASD-II group(all P < 0.05),ASD-I group was significantly lower than ASD-II group(P < 0.05);(4)PVR was 1.38 ± 0.59 WU,2.09 ±0.62 WU and 7.83±4.98 WU,respectively,with significant differences among the three groups(all P<0.05).3.In ASD-I group and ASD-II group,ASD-III group,the serum HDL-C level was 1.31 ± 0.31mmol/l,1.15 ± 0.31mmol/l and 1.13 ± 0.33mmol/l,respectively.The serum HDL-C level in the three groups was significantly lower than those in the control group(1.55±0.39mmol/l)(all P<0.05).4.From ASD-I group to ASD-III group,the serum HDL-C level tended to decrease gradually.The serum HDL-C level of ASD-II and ASD-III group was significantly lower than that of ASD-I group(all P<0.05),but there was no significant differences between ASD-II and ASD-III group.(P>0.05).5.Serum HDL-C level in adult ASD patients was significantly negatively correlated with mPAP(r=-0.24)and Pp/Ps(r=-0.19),(all P<0.05),but not with PVR(r=-0.16,P>0.05).Conclusions:1.With elevation of PAP and PVR in adult ASD patients,some of them developed to patients with moderate to severe PAH.2.The serum HDL-C level of adult ASD patients with or without PH was significantly lower than that of normal subjects.3.During the progression of PH,the serum HDL-C level of adult ASD patients was gradually down-regulated,and the serum HDL-C level of patients was negatively correlated with mPAP and Pp/Ps.It is suggested that HDL-C is involved in the occurrence and development of PH secondary to ASD in adults.