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Impact of residual right ventricular outflow tract obstruction on biventricular strain and synchrony in patients after repair of tetralogy of Fallot: a cardiac magnetic resonance feature tracking study.
Eur J Cardiothorac Surg. 2015 Jul; 48(1):83-90.EJ

Abstract

OBJECTIVES

Residual right ventricular outflow tract (RVOT) obstruction (RVOTO) is considered beneficial in patients after repair of tetralogy of Fallot (TOF) although underlying mechanisms are unknown. We sought to elucidate differences in myocardial strain and dyssynchrony parameters in patients after TOF repair with and without residual RVOTO using cardiovascular magnetic resonance (CMR) feature-tracking (CMR-FT) analysis.

METHODS

Fifty-four patients (mean age 16.4 ± 8.4 years) were assessed by CMR 14.2 ± 7.3 years after repair of TOF. Residual RVOTO on echocardiography was defined as a peak systolic RVOT gradient >25 mmHg and was present in 27 patients (no RVOTO in n = 27 patients). Right ventricular (RV) and left ventricular (LV) strain measurements were performed using CMR-FT software.

RESULTS

The two groups were well matched for age at CMR scan, time and type of surgical repair. There was no difference in the degree of pulmonary regurgitation (PR) and RV end-diastolic volume. Patients with RVOTO showed significant higher RV circumferential strain (CS) (P = 0.02) and RV radial strain (RS) (P = 0.02) values, whereas RV longitudinal strain (LS) did not differ between the two groups (P = 0.39). The degree of RVOTO showed a significant correlation with RV-CS (r = 0.37; P = 0.006) and RV-RS (r = 0.30; P = 0.03) while RV-LS was unrelated to RVOTO (r = 0.06; P = 0.68). Significant relationships between RV and LV strain parameters were only found in the RVOTO group. Interventricular dyssynchrony was significantly higher in the group without RVOTO (P = 0.03) while LV-LS (P = 0.03) and LV intraventricular synchrony (P = 0.05) were impaired in the RVOTO group.

CONCLUSIONS

In patients after TOF repair, residual RVOTO seems to preserve RV strain and results in stronger RV-LV interactions and less interventricular dyssynchrony and may therefore possess an early protective effect on RV remodelling. However, the potential negative impact of residual pulmonary stenosis on LV strain and intraventricular synchrony needs further investigation.

Authors+Show Affiliations

Pediatric Heart Centre, University Children's Hospital, Giessen, Germany heiner.latus@googlemail.com.Pediatric Heart Centre, University Children's Hospital, Giessen, Germany.Pediatric Heart Centre, University Children's Hospital, Giessen, Germany.Pediatric Heart Centre, University Children's Hospital, Giessen, Germany.Pediatric Heart Centre, University Children's Hospital, Giessen, Germany.Pediatric Heart Centre, University Children's Hospital, Giessen, Germany.Pediatric Heart Centre, University Children's Hospital, Giessen, Germany.Pediatric Heart Centre, University Children's Hospital, Giessen, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25378364

Citation

Latus, Heiner, et al. "Impact of Residual Right Ventricular Outflow Tract Obstruction On Biventricular Strain and Synchrony in Patients After Repair of Tetralogy of Fallot: a Cardiac Magnetic Resonance Feature Tracking Study." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 48, no. 1, 2015, pp. 83-90.
Latus H, Hachmann P, Gummel K, et al. Impact of residual right ventricular outflow tract obstruction on biventricular strain and synchrony in patients after repair of tetralogy of Fallot: a cardiac magnetic resonance feature tracking study. Eur J Cardiothorac Surg. 2015;48(1):83-90.
Latus, H., Hachmann, P., Gummel, K., Khalil, M., Yerebakan, C., Bauer, J., Schranz, D., & Apitz, C. (2015). Impact of residual right ventricular outflow tract obstruction on biventricular strain and synchrony in patients after repair of tetralogy of Fallot: a cardiac magnetic resonance feature tracking study. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 48(1), 83-90. https://doi.org/10.1093/ejcts/ezu396
Latus H, et al. Impact of Residual Right Ventricular Outflow Tract Obstruction On Biventricular Strain and Synchrony in Patients After Repair of Tetralogy of Fallot: a Cardiac Magnetic Resonance Feature Tracking Study. Eur J Cardiothorac Surg. 2015;48(1):83-90. PubMed PMID: 25378364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of residual right ventricular outflow tract obstruction on biventricular strain and synchrony in patients after repair of tetralogy of Fallot: a cardiac magnetic resonance feature tracking study. AU - Latus,Heiner, AU - Hachmann,Pauline, AU - Gummel,Kerstin, AU - Khalil,Markus, AU - Yerebakan,Can, AU - Bauer,Juergen, AU - Schranz,Dietmar, AU - Apitz,Christian, Y1 - 2014/11/05/ PY - 2014/06/07/received PY - 2014/09/02/accepted PY - 2014/11/8/entrez PY - 2014/11/8/pubmed PY - 2016/4/9/medline KW - CMR feature tracking KW - Residual pulmonary stenosis KW - Tetralogy of Fallot SP - 83 EP - 90 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 48 IS - 1 N2 - OBJECTIVES: Residual right ventricular outflow tract (RVOT) obstruction (RVOTO) is considered beneficial in patients after repair of tetralogy of Fallot (TOF) although underlying mechanisms are unknown. We sought to elucidate differences in myocardial strain and dyssynchrony parameters in patients after TOF repair with and without residual RVOTO using cardiovascular magnetic resonance (CMR) feature-tracking (CMR-FT) analysis. METHODS: Fifty-four patients (mean age 16.4 ± 8.4 years) were assessed by CMR 14.2 ± 7.3 years after repair of TOF. Residual RVOTO on echocardiography was defined as a peak systolic RVOT gradient >25 mmHg and was present in 27 patients (no RVOTO in n = 27 patients). Right ventricular (RV) and left ventricular (LV) strain measurements were performed using CMR-FT software. RESULTS: The two groups were well matched for age at CMR scan, time and type of surgical repair. There was no difference in the degree of pulmonary regurgitation (PR) and RV end-diastolic volume. Patients with RVOTO showed significant higher RV circumferential strain (CS) (P = 0.02) and RV radial strain (RS) (P = 0.02) values, whereas RV longitudinal strain (LS) did not differ between the two groups (P = 0.39). The degree of RVOTO showed a significant correlation with RV-CS (r = 0.37; P = 0.006) and RV-RS (r = 0.30; P = 0.03) while RV-LS was unrelated to RVOTO (r = 0.06; P = 0.68). Significant relationships between RV and LV strain parameters were only found in the RVOTO group. Interventricular dyssynchrony was significantly higher in the group without RVOTO (P = 0.03) while LV-LS (P = 0.03) and LV intraventricular synchrony (P = 0.05) were impaired in the RVOTO group. CONCLUSIONS: In patients after TOF repair, residual RVOTO seems to preserve RV strain and results in stronger RV-LV interactions and less interventricular dyssynchrony and may therefore possess an early protective effect on RV remodelling. However, the potential negative impact of residual pulmonary stenosis on LV strain and intraventricular synchrony needs further investigation. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/25378364/Impact_of_residual_right_ventricular_outflow_tract_obstruction_on_biventricular_strain_and_synchrony_in_patients_after_repair_of_tetralogy_of_Fallot:_a_cardiac_magnetic_resonance_feature_tracking_study_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezu396 DB - PRIME DP - Unbound Medicine ER -