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Patients with repaired tetralogy of Fallot suffer from intra- and inter-ventricular cardiac dyssynchrony: a cardiac magnetic resonance study.
Eur Heart J Cardiovasc Imaging. 2014 Dec; 15(12):1333-43.EH

Abstract

AIMS

Patients with repaired tetralogy of Fallot (rTOF) frequently have right bundle branch block. To better understand the contribution of cardiac dyssynchrony to dysfunction, we developed a method to quantify left (LV), right (RV), and inter-ventricular dyssynchrony using standard cine cardiac magnetic resonance (CMR).

METHODS AND RESULTS

Thirty patients with rTOF and 17 healthy controls underwent cine CMR. Patients were imaged twice to assess inter-test reproducibility. Circumferential strain curves were generated with a custom feature-tracking algorithm for 12 LV and 12 RV segments in each of 4-7 short-axis slices encompassing the ventricles. Temporal offsets (TOs, in ms) of the strain curves relative to a patient-specific reference curve were calculated. The intra-ventricular dyssynchrony index (DI) for each ventricle was computed as the standard deviation of the TOs. The inter-ventricular DI was calculated as the difference in median RV and median LV TOs. Compared with controls, patients had a greater LV DI (21 ± 8 vs. 11 ± 5 ms, P < 0.001) and RV DI (60 ± 19 vs. 47 ± 17 ms, P = 0.02). RV contraction was globally delayed in patients, resulting in a greater inter-ventricular DI with the RV contracting 45 ± 25 ms later than the LV vs. 12 ± 29 ms earlier in controls (P < 0.001). Inter-test reproducibility was moderate with all coefficients of variation ≤22%. Both LV and RV DIs were correlated with measures of LV, but not RV, function.

CONCLUSION

Patients with rTOF have intra- and inter-ventricular dyssynchrony, which can be quantified from standard cine CMR. This new approach can potentially help determine the contribution of dyssynchrony to ventricular dysfunction in future studies.

Authors+Show Affiliations

Departments of Pediatrics, Physiology, Biomedical Engineering and Medicine, University of Kentucky, UK Chandler Hospital, 741 S Limestone, BBSRB B353, Lexington, KY 40536, USA.Departments of Pediatrics, Physiology, Biomedical Engineering and Medicine, University of Kentucky, UK Chandler Hospital, 741 S Limestone, BBSRB B353, Lexington, KY 40536, USA.Departments of Pediatrics, Physiology, Biomedical Engineering and Medicine, University of Kentucky, UK Chandler Hospital, 741 S Limestone, BBSRB B353, Lexington, KY 40536, USA.Departments of Pediatrics, Physiology, Biomedical Engineering and Medicine, University of Kentucky, UK Chandler Hospital, 741 S Limestone, BBSRB B353, Lexington, KY 40536, USA.Department of Cardiology, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA.Department of Cardiology, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA.Scientific Imaging and Visualization LLC, Atlanta, GA, USA.Department of Cardiology, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA.Department of Cardiology, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA.Departments of Pediatrics, Physiology, Biomedical Engineering and Medicine, University of Kentucky, UK Chandler Hospital, 741 S Limestone, BBSRB B353, Lexington, KY 40536, USA bkf@gatech.edu b.f@uky.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24996664

Citation

Jing, Linyuan, et al. "Patients With Repaired Tetralogy of Fallot Suffer From Intra- and Inter-ventricular Cardiac Dyssynchrony: a Cardiac Magnetic Resonance Study." European Heart Journal Cardiovascular Imaging, vol. 15, no. 12, 2014, pp. 1333-43.
Jing L, Haggerty CM, Suever JD, et al. Patients with repaired tetralogy of Fallot suffer from intra- and inter-ventricular cardiac dyssynchrony: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging. 2014;15(12):1333-43.
Jing, L., Haggerty, C. M., Suever, J. D., Alhadad, S., Prakash, A., Cecchin, F., Skrinjar, O., Geva, T., Powell, A. J., & Fornwalt, B. K. (2014). Patients with repaired tetralogy of Fallot suffer from intra- and inter-ventricular cardiac dyssynchrony: a cardiac magnetic resonance study. European Heart Journal Cardiovascular Imaging, 15(12), 1333-43. https://doi.org/10.1093/ehjci/jeu123
Jing L, et al. Patients With Repaired Tetralogy of Fallot Suffer From Intra- and Inter-ventricular Cardiac Dyssynchrony: a Cardiac Magnetic Resonance Study. Eur Heart J Cardiovasc Imaging. 2014;15(12):1333-43. PubMed PMID: 24996664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patients with repaired tetralogy of Fallot suffer from intra- and inter-ventricular cardiac dyssynchrony: a cardiac magnetic resonance study. AU - Jing,Linyuan, AU - Haggerty,Christopher M, AU - Suever,Jonathan D, AU - Alhadad,Sudad, AU - Prakash,Ashwin, AU - Cecchin,Frank, AU - Skrinjar,Oskar, AU - Geva,Tal, AU - Powell,Andrew J, AU - Fornwalt,Brandon K, Y1 - 2014/07/04/ PY - 2014/7/6/entrez PY - 2014/7/6/pubmed PY - 2015/9/12/medline KW - Cardiac magnetic resonance KW - Dyssynchrony KW - Magnetic resonance imaging KW - Tetralogy of Fallot SP - 1333 EP - 43 JF - European heart journal cardiovascular Imaging JO - Eur Heart J Cardiovasc Imaging VL - 15 IS - 12 N2 - AIMS: Patients with repaired tetralogy of Fallot (rTOF) frequently have right bundle branch block. To better understand the contribution of cardiac dyssynchrony to dysfunction, we developed a method to quantify left (LV), right (RV), and inter-ventricular dyssynchrony using standard cine cardiac magnetic resonance (CMR). METHODS AND RESULTS: Thirty patients with rTOF and 17 healthy controls underwent cine CMR. Patients were imaged twice to assess inter-test reproducibility. Circumferential strain curves were generated with a custom feature-tracking algorithm for 12 LV and 12 RV segments in each of 4-7 short-axis slices encompassing the ventricles. Temporal offsets (TOs, in ms) of the strain curves relative to a patient-specific reference curve were calculated. The intra-ventricular dyssynchrony index (DI) for each ventricle was computed as the standard deviation of the TOs. The inter-ventricular DI was calculated as the difference in median RV and median LV TOs. Compared with controls, patients had a greater LV DI (21 ± 8 vs. 11 ± 5 ms, P < 0.001) and RV DI (60 ± 19 vs. 47 ± 17 ms, P = 0.02). RV contraction was globally delayed in patients, resulting in a greater inter-ventricular DI with the RV contracting 45 ± 25 ms later than the LV vs. 12 ± 29 ms earlier in controls (P < 0.001). Inter-test reproducibility was moderate with all coefficients of variation ≤22%. Both LV and RV DIs were correlated with measures of LV, but not RV, function. CONCLUSION: Patients with rTOF have intra- and inter-ventricular dyssynchrony, which can be quantified from standard cine CMR. This new approach can potentially help determine the contribution of dyssynchrony to ventricular dysfunction in future studies. SN - 2047-2412 UR - https://www.unboundmedicine.com/medline/citation/24996664/Patients_with_repaired_tetralogy_of_Fallot_suffer_from_intra__and_inter_ventricular_cardiac_dyssynchrony:_a_cardiac_magnetic_resonance_study_ L2 - https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jeu123 DB - PRIME DP - Unbound Medicine ER -