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Impact of the cone operation on left ventricular size, function, and dyssynchrony in Ebstein anomaly: a cardiovascular magnetic resonance study.
J Cardiovasc Magn Reson. 2018 05 21; 20(1):32.JC

Abstract

BACKGROUND

In addition to tricuspid regurgitation (TR) and right ventricular (RV) enlargement, patients with Ebstein anomaly are at risk for left ventricular (LV) dysfunction and dyssynchrony. We studied the impact of the cone tricuspid valve reconstruction operation on LV size, function, and dyssynchrony.

METHODS

All Ebstein anomaly patients who had both pre- and postoperative cardiovascular magnetic resonance (CMR) studies were retrospectively identified. From cine images, RV and LV volumes and ejection fractions (EF) were calculated, and LV circumferential and longitudinal strain were measured by feature tracking. To quantify LV dyssynchrony, temporal offsets (TOs) were computed among segmental circumferential strain versus time curves using cross-correlation analysis and patient-specific reference curves. An LV dyssynchrony index was calculated as the standard deviation of the TOs.

RESULTS

Twenty patients (65% female) were included with a median age at cone operation of 16 years, and a median time between pre- and postoperative CMR of 2.8 years. Postoperatively, there was a decline in the TR fraction (56 ± 19% vs. 5 ± 4%, p < 0.001), RV end-diastolic volume (EDV) (242 ± 110 ml/m2 vs. 137 ± 82 ml/m2, p < 0.001), and RV stroke volume (SV) (101 ± 35 vs. 51 ± 7 ml/m2, p < 0.001). RV EF was unchanged. Conversely, there was an increase in both LV EDV (68 ± 13 vs. 85 ± 13 ml/m2, p < 0.001) and LV stroke volume (37 ± 8 vs. 48 ± 6 ml/m2, p < 0.001). There was no change in LV EF, or global circumferential and longitudinal strain but basal septal circumferential strain improved (16 ± 7% vs. 22 ± 5%, p = 0.04). LV contraction become more synchronous (dyssynchrony index: 32 ± 17 vs. 21 ± 9 msec, p = 0.02), and the extent correlated with the reduction in RV EDV and TR.

CONCLUSIONS

In patients with the Ebstein anomaly, the cone operation led to reduced TR and RV stroke volume, increased LV stroke volume, improved LV basal septal strain, and improved LV synchrony. Our data demonstrates that the detrimental effect of the RV on LV function can be mitigated by the cone operation.

Authors+Show Affiliations

Department of Pediatrics, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA. rsberoukhim@partners.org. Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. rsberoukhim@partners.org. Department of Pediatrics, Harvard Medical School, Boston, MA, USA. rsberoukhim@partners.org.Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. Department of Pediatrics, Harvard Medical School, Boston, MA, USA.Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA. Department of Radiology, Geisinger, Danville, PA, USA.Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. Department of Pediatrics, Harvard Medical School, Boston, MA, USA.Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA. Department of Surgery, 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.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29783986

Citation

Beroukhim, Rebecca S., et al. "Impact of the Cone Operation On Left Ventricular Size, Function, and Dyssynchrony in Ebstein Anomaly: a Cardiovascular Magnetic Resonance Study." Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, vol. 20, no. 1, 2018, p. 32.
Beroukhim RS, Jing L, Harrild DM, et al. Impact of the cone operation on left ventricular size, function, and dyssynchrony in Ebstein anomaly: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2018;20(1):32.
Beroukhim, R. S., Jing, L., Harrild, D. M., Fornwalt, B. K., Mejia-Spiegeler, A., Rhodes, J., Emani, S., & Powell, A. J. (2018). Impact of the cone operation on left ventricular size, function, and dyssynchrony in Ebstein anomaly: a cardiovascular magnetic resonance study. Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, 20(1), 32. https://doi.org/10.1186/s12968-018-0452-0
Beroukhim RS, et al. Impact of the Cone Operation On Left Ventricular Size, Function, and Dyssynchrony in Ebstein Anomaly: a Cardiovascular Magnetic Resonance Study. J Cardiovasc Magn Reson. 2018 05 21;20(1):32. PubMed PMID: 29783986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of the cone operation on left ventricular size, function, and dyssynchrony in Ebstein anomaly: a cardiovascular magnetic resonance study. AU - Beroukhim,Rebecca S, AU - Jing,Linyuan, AU - Harrild,David M, AU - Fornwalt,Brandon K, AU - Mejia-Spiegeler,Abba, AU - Rhodes,Jonathan, AU - Emani,Sitaram, AU - Powell,Andrew J, Y1 - 2018/05/21/ PY - 2018/01/17/received PY - 2018/04/10/accepted PY - 2018/5/23/entrez PY - 2018/5/23/pubmed PY - 2019/3/15/medline KW - Cardiovascular magnetic resonance KW - Cone operation KW - Dyssynchrony KW - Ebstein anomaly KW - Strain SP - 32 EP - 32 JF - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JO - J Cardiovasc Magn Reson VL - 20 IS - 1 N2 - BACKGROUND: In addition to tricuspid regurgitation (TR) and right ventricular (RV) enlargement, patients with Ebstein anomaly are at risk for left ventricular (LV) dysfunction and dyssynchrony. We studied the impact of the cone tricuspid valve reconstruction operation on LV size, function, and dyssynchrony. METHODS: All Ebstein anomaly patients who had both pre- and postoperative cardiovascular magnetic resonance (CMR) studies were retrospectively identified. From cine images, RV and LV volumes and ejection fractions (EF) were calculated, and LV circumferential and longitudinal strain were measured by feature tracking. To quantify LV dyssynchrony, temporal offsets (TOs) were computed among segmental circumferential strain versus time curves using cross-correlation analysis and patient-specific reference curves. An LV dyssynchrony index was calculated as the standard deviation of the TOs. RESULTS: Twenty patients (65% female) were included with a median age at cone operation of 16 years, and a median time between pre- and postoperative CMR of 2.8 years. Postoperatively, there was a decline in the TR fraction (56 ± 19% vs. 5 ± 4%, p < 0.001), RV end-diastolic volume (EDV) (242 ± 110 ml/m2 vs. 137 ± 82 ml/m2, p < 0.001), and RV stroke volume (SV) (101 ± 35 vs. 51 ± 7 ml/m2, p < 0.001). RV EF was unchanged. Conversely, there was an increase in both LV EDV (68 ± 13 vs. 85 ± 13 ml/m2, p < 0.001) and LV stroke volume (37 ± 8 vs. 48 ± 6 ml/m2, p < 0.001). There was no change in LV EF, or global circumferential and longitudinal strain but basal septal circumferential strain improved (16 ± 7% vs. 22 ± 5%, p = 0.04). LV contraction become more synchronous (dyssynchrony index: 32 ± 17 vs. 21 ± 9 msec, p = 0.02), and the extent correlated with the reduction in RV EDV and TR. CONCLUSIONS: In patients with the Ebstein anomaly, the cone operation led to reduced TR and RV stroke volume, increased LV stroke volume, improved LV basal septal strain, and improved LV synchrony. Our data demonstrates that the detrimental effect of the RV on LV function can be mitigated by the cone operation. SN - 1532-429X UR - https://www.unboundmedicine.com/medline/citation/29783986/Impact_of_the_cone_operation_on_left_ventricular_size_function_and_dyssynchrony_in_Ebstein_anomaly:_a_cardiovascular_magnetic_resonance_study_ L2 - https://jcmr-online.biomedcentral.com/articles/10.1186/s12968-018-0452-0 DB - PRIME DP - Unbound Medicine ER -