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Impact of surgical pulmonary valve replacement on ventricular strain and synchrony in patients with repaired tetralogy of Fallot: a cardiovascular magnetic resonance feature tracking study.
J Cardiovasc Magn Reson. 2018 06 18; 20(1):37.JC

Abstract

BACKGROUND

In patients with repaired tetralogy of Fallot (TOF), a better understanding of the impact of surgical pulmonary valve replacement (PVR) on ventricular mechanics may lead to improved indications and outcomes. Therefore, we used cardiovascular magnetic resonance (CMR) feature tracking analysis to quantify ventricular strain and synchrony in repaired TOF patients before and after PVR.

METHODS

Thirty-six repaired TOF patients (median age 22.4 years) prospectively underwent CMR a mean of 4.5 ± 3.8 months before PVR surgery and 7.3 ± 2.1 months after PVR surgery. Feature tracking analysis on cine steady-state free precession images was used to measure right ventricular (RV) and left ventricular (LV) circumferential strain from short-axis views at basal, mid-ventricular, and apical levels; and longitudinal strain from 4-chamber views. Intraventricular synchrony was quantified using the maximum difference in time-to-peak strain, the standard deviation of the time-to-peak, and cross correlation delay (CCD) metrics; interventricular synchrony was assessed using the CCD metric.

RESULTS

Following PVR, RV end-diastolic volume, end-systolic volume, and ejection fraction declined, and LV end-diastolic volume and end-systolic volume both increased with no significant change in the LV ejection fraction. LV global basal and apical circumferential strains, and basal synchrony improved. RV global circumferential and longitudinal strains were unchanged, and there was a varied impact on synchrony across the locations. Interventricular synchrony worsened at the midventricular level but was unchanged at the base and apex, and on 4-chamber views.

CONCLUSIONS

Surgical PVR in repaired TOF patients led to improved LV global strain and no change in RV global strain. LV and RV synchrony parameters improved or were unchanged, and interventricular synchrony worsened at the midventricular level.

Authors+Show Affiliations

Department of Cardiology, Boston Children's Hospital, Boston, USA. sowmyab@med.umich.edu. Department of Pediatrics, Harvard Medical School, Boston, USA. sowmyab@med.umich.edu.Department of Cardiology, Boston Children's Hospital, Boston, USA. Department of Pediatrics, Harvard Medical School, Boston, USA.Department of Cardiology, Boston Children's Hospital, Boston, USA.Department of Cardiology, Boston Children's Hospital, Boston, USA. Department of Pediatrics, Harvard Medical School, Boston, USA.Department of Cardiac Surgery, Boston Children's Hospital, Boston, USA. Department of Surgery, Boston Children's Hospital, Boston, USA.Department of Cardiology, Boston Children's Hospital, Boston, USA. Department of Pediatrics, Harvard Medical School, Boston, USA.Department of Cardiology, Boston Children's Hospital, Boston, USA. Department of Pediatrics, Harvard Medical School, Boston, USA.

Pub Type(s)

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

Language

eng

PubMed ID

29909772

Citation

Balasubramanian, Sowmya, et al. "Impact of Surgical Pulmonary Valve Replacement On Ventricular Strain and Synchrony in Patients With Repaired Tetralogy of Fallot: a Cardiovascular Magnetic Resonance Feature Tracking Study." Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, vol. 20, no. 1, 2018, p. 37.
Balasubramanian S, Harrild DM, Kerur B, et al. Impact of surgical pulmonary valve replacement on ventricular strain and synchrony in patients with repaired tetralogy of Fallot: a cardiovascular magnetic resonance feature tracking study. J Cardiovasc Magn Reson. 2018;20(1):37.
Balasubramanian, S., Harrild, D. M., Kerur, B., Marcus, E., Del Nido, P., Geva, T., & Powell, A. J. (2018). Impact of surgical pulmonary valve replacement on ventricular strain and synchrony in patients with repaired tetralogy of Fallot: a cardiovascular magnetic resonance feature tracking study. Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, 20(1), 37. https://doi.org/10.1186/s12968-018-0460-0
Balasubramanian S, et al. Impact of Surgical Pulmonary Valve Replacement On Ventricular Strain and Synchrony in Patients With Repaired Tetralogy of Fallot: a Cardiovascular Magnetic Resonance Feature Tracking Study. J Cardiovasc Magn Reson. 2018 06 18;20(1):37. PubMed PMID: 29909772.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of surgical pulmonary valve replacement on ventricular strain and synchrony in patients with repaired tetralogy of Fallot: a cardiovascular magnetic resonance feature tracking study. AU - Balasubramanian,Sowmya, AU - Harrild,David M, AU - Kerur,Basavaraj, AU - Marcus,Edward, AU - Del Nido,Pedro, AU - Geva,Tal, AU - Powell,Andrew J, Y1 - 2018/06/18/ PY - 2017/11/07/received PY - 2018/05/22/accepted PY - 2018/6/19/entrez PY - 2018/6/19/pubmed PY - 2019/3/15/medline KW - Feature tracking KW - Myocardial strain KW - Pulmonary valve replacement KW - Tetralogy of fallot KW - Ventricular synchrony SP - 37 EP - 37 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 patients with repaired tetralogy of Fallot (TOF), a better understanding of the impact of surgical pulmonary valve replacement (PVR) on ventricular mechanics may lead to improved indications and outcomes. Therefore, we used cardiovascular magnetic resonance (CMR) feature tracking analysis to quantify ventricular strain and synchrony in repaired TOF patients before and after PVR. METHODS: Thirty-six repaired TOF patients (median age 22.4 years) prospectively underwent CMR a mean of 4.5 ± 3.8 months before PVR surgery and 7.3 ± 2.1 months after PVR surgery. Feature tracking analysis on cine steady-state free precession images was used to measure right ventricular (RV) and left ventricular (LV) circumferential strain from short-axis views at basal, mid-ventricular, and apical levels; and longitudinal strain from 4-chamber views. Intraventricular synchrony was quantified using the maximum difference in time-to-peak strain, the standard deviation of the time-to-peak, and cross correlation delay (CCD) metrics; interventricular synchrony was assessed using the CCD metric. RESULTS: Following PVR, RV end-diastolic volume, end-systolic volume, and ejection fraction declined, and LV end-diastolic volume and end-systolic volume both increased with no significant change in the LV ejection fraction. LV global basal and apical circumferential strains, and basal synchrony improved. RV global circumferential and longitudinal strains were unchanged, and there was a varied impact on synchrony across the locations. Interventricular synchrony worsened at the midventricular level but was unchanged at the base and apex, and on 4-chamber views. CONCLUSIONS: Surgical PVR in repaired TOF patients led to improved LV global strain and no change in RV global strain. LV and RV synchrony parameters improved or were unchanged, and interventricular synchrony worsened at the midventricular level. SN - 1532-429X UR - https://www.unboundmedicine.com/medline/citation/29909772/Impact_of_surgical_pulmonary_valve_replacement_on_ventricular_strain_and_synchrony_in_patients_with_repaired_tetralogy_of_Fallot:_a_cardiovascular_magnetic_resonance_feature_tracking_study_ L2 - https://jcmr-online.biomedcentral.com/articles/10.1186/s12968-018-0460-0 DB - PRIME DP - Unbound Medicine ER -