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Assessment of ventricular function in adults with repaired Tetralogy of Fallot using myocardial deformation imaging.
Eur Heart J Cardiovasc Imaging. 2015 Dec; 16(12):1347-57.EH

Abstract

AIMS

Many patients with repaired Tetralogy of Fallot (ToF) have right ventricular (RV) volume overload due to pulmonary regurgitation (PR). We studied the effect of volume overload on global and regional RV and left ventricular (LV) deformation, and their relationships with conventional diagnostic parameters.

METHODS AND RESULTS

In this cross-sectional study, 94 prospectively recruited ToF patients (61% male, age 32.8 ± 9.5 years, age at repair 1.9 [0.8-5.7] years, 39% pulmonary homograft) and 85 healthy controls of similar age and sex underwent echocardiography and electrocardiography. In a subset of patients, cardiac magnetic resonance imaging, bicycle ergometry, and NT-proBNP measurement were performed within the same day. With speckle-tracking echocardiography, we analysed peak systolic global longitudinal strain (GLS), segmental longitudinal strain and strain rate of the RV free wall, LV lateral wall, and septum. Patients had a lower RV free wall strain than controls (-18.1 ± 4.5 vs. -26.5 ± 4.5%, P < 0.001), especially at the apical segment (-15.9 ± 7.4 vs. -28.2 ± 7.7%, P < 0.001), and lower RV strain rate. LV GLS was also lower (-17.4 ± 2.5 vs. -19.6 ± 1.9%, P < 0.001), mainly due to the interventricular septum. Patients with PR >25% had higher LV GLS and RV free wall strain than patients with PR ≤25% (P = 0.004, P = 0.039, respectively). No relationships were found with NT-proBNP or exercise capacity.

CONCLUSION

RV free wall strain and strain rate are decreased in adults late after ToF repair, especially at the apical segment suggesting that apical function is most affected in these RVs. Regarding the LV, septal strain is decreased indicating that RV dysfunction adversely affects LV function, probably by mechanical coupling of the ventricles.

Authors+Show Affiliations

Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.Department of Pediatrics, Division of Pediatric Cardiology, Sophia's Children's Hospital-Erasmus MC, Rotterdam, the Netherlands.Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands j.roos@erasmusmc.nl.

Pub Type(s)

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

Language

eng

PubMed ID

26224483

Citation

Menting, Myrthe E., et al. "Assessment of Ventricular Function in Adults With Repaired Tetralogy of Fallot Using Myocardial Deformation Imaging." European Heart Journal Cardiovascular Imaging, vol. 16, no. 12, 2015, pp. 1347-57.
Menting ME, van den Bosch AE, McGhie JS, et al. Assessment of ventricular function in adults with repaired Tetralogy of Fallot using myocardial deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16(12):1347-57.
Menting, M. E., van den Bosch, A. E., McGhie, J. S., Eindhoven, J. A., Cuypers, J. A., Witsenburg, M., Geleijnse, M. L., Helbing, W. A., & Roos-Hesselink, J. W. (2015). Assessment of ventricular function in adults with repaired Tetralogy of Fallot using myocardial deformation imaging. European Heart Journal Cardiovascular Imaging, 16(12), 1347-57. https://doi.org/10.1093/ehjci/jev090
Menting ME, et al. Assessment of Ventricular Function in Adults With Repaired Tetralogy of Fallot Using Myocardial Deformation Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(12):1347-57. PubMed PMID: 26224483.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of ventricular function in adults with repaired Tetralogy of Fallot using myocardial deformation imaging. AU - Menting,Myrthe E, AU - van den Bosch,Annemien E, AU - McGhie,Jackie S, AU - Eindhoven,Jannet A, AU - Cuypers,Judith A A E, AU - Witsenburg,Maarten, AU - Geleijnse,Marcel L, AU - Helbing,Willem A, AU - Roos-Hesselink,Jolien W, Y1 - 2015/07/29/ PY - 2015/02/11/received PY - 2015/03/21/accepted PY - 2015/7/31/entrez PY - 2015/8/1/pubmed PY - 2016/9/7/medline KW - Tetralogy of Fallot KW - myocardial deformation KW - speckle-tracking echocardiography KW - strain KW - strain rate SP - 1347 EP - 57 JF - European heart journal cardiovascular Imaging JO - Eur Heart J Cardiovasc Imaging VL - 16 IS - 12 N2 - AIMS: Many patients with repaired Tetralogy of Fallot (ToF) have right ventricular (RV) volume overload due to pulmonary regurgitation (PR). We studied the effect of volume overload on global and regional RV and left ventricular (LV) deformation, and their relationships with conventional diagnostic parameters. METHODS AND RESULTS: In this cross-sectional study, 94 prospectively recruited ToF patients (61% male, age 32.8 ± 9.5 years, age at repair 1.9 [0.8-5.7] years, 39% pulmonary homograft) and 85 healthy controls of similar age and sex underwent echocardiography and electrocardiography. In a subset of patients, cardiac magnetic resonance imaging, bicycle ergometry, and NT-proBNP measurement were performed within the same day. With speckle-tracking echocardiography, we analysed peak systolic global longitudinal strain (GLS), segmental longitudinal strain and strain rate of the RV free wall, LV lateral wall, and septum. Patients had a lower RV free wall strain than controls (-18.1 ± 4.5 vs. -26.5 ± 4.5%, P < 0.001), especially at the apical segment (-15.9 ± 7.4 vs. -28.2 ± 7.7%, P < 0.001), and lower RV strain rate. LV GLS was also lower (-17.4 ± 2.5 vs. -19.6 ± 1.9%, P < 0.001), mainly due to the interventricular septum. Patients with PR >25% had higher LV GLS and RV free wall strain than patients with PR ≤25% (P = 0.004, P = 0.039, respectively). No relationships were found with NT-proBNP or exercise capacity. CONCLUSION: RV free wall strain and strain rate are decreased in adults late after ToF repair, especially at the apical segment suggesting that apical function is most affected in these RVs. Regarding the LV, septal strain is decreased indicating that RV dysfunction adversely affects LV function, probably by mechanical coupling of the ventricles. SN - 2047-2412 UR - https://www.unboundmedicine.com/medline/citation/26224483/Assessment_of_ventricular_function_in_adults_with_repaired_Tetralogy_of_Fallot_using_myocardial_deformation_imaging_ L2 - https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jev090 DB - PRIME DP - Unbound Medicine ER -