Assessment of interventricular and right-intraventricular dyssynchrony in patients with surgically repaired tetralogy of Fallot by two-dimensional speckle tracking

Müeller, Matthias; Rentzsch, Axel; Hoetzer, Kai; Raedle-Hurst, Tanja; Boettler, Petra; Stiller, Brigitte; Lemmer, Julia; Sarikouch, Samir; Beerbaum, Philipp; Peters, Brigitte; Vogt, Manfred; Vogel, Michael; Abdul‐Khaliq, Hashim

doi:10.1093/ejechocard/jeq067

Cited by 33 publications

(27 citation statements)

References 22 publications

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“…1,2 Similarly, right bundle branch block (RBBB) is common, and prolonged QRS duration conveys risk for adverse outcome. 3 Although electromechanical abnormalities are recognized in this population, 2,[4][5][6] specific patterns of regional mechanical abnormalities induced by abnormal electric activation associated with RBBB have not been studied. In left bundle branch block (LBBB), abnormal electric activation leads to a typical mechanical dyssynchrony pattern characterized by early septal activation, observed echocardiographically as a septal flash, with concomitant lateral wall prestretch and late contraction of the early-stretched lateral wall.…”

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confidence: 99%

Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot

Wang

Slorach

Dragulescu

et al. 2014

Circ: Cardiovascular Imaging

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Background-Right bundle branch block and right ventricular (RV) dysfunction are common after tetralogy of Fallot repair (rTOF). We hypothesized that right bundle branch block is associated with specific RV mechanical dyssynchrony and inefficient contraction. Methods and Results-We studied rTOF children and age-matched controls. QRS duration and morphology were assessed. RV mechanical dyssynchrony, indicated by early septal activation (right-sided septal flash), RV lateral wall prestretch/late contraction, postsystolic shortening, and intraventricular delay were analyzed using 2-dimensional strain echocardiography. Peak oxygen consumption reflected exercise capacity. Pulmonary regurgitation and RV volumes were assessed by MRI. Forty-six rTOF patients and 46 controls were studied. Ninety-three percent of rTOF patients demonstrated a right-sided septal flash with simultaneous RV basal lateral wall prestretch/late activation. The RV basal segment was the most delayed in onset (115 [0-194]

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confidence: 99%

Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot

Wang

Slorach

Dragulescu

et al. 2014

Circ: Cardiovascular Imaging

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“…Patients with dysfunctional RVOT conduits have been shown to exhibit dyssynchronous interventricular contraction associated with factors such as baseline RV strain, EF, and end-systolic and diastolic volumes. 35 In a cohort of patients with TOF, LV dyssynchrony has been associated with ventricular tachycardia and death.14 Given these associations, we chose to investigate the impact of TPV replacement on ventricular synchrony. Several measures were investigated given the lack of general consensus in the literature regarding the most appropriate index of ventricular synchrony; as well, we included a new measure known as cross-correlation delay which is potentially more robust than traditional indices.…”

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confidence: 99%

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confidence: 99%

Impact of Transcatheter Pulmonary Valve Replacement on Biventricular Strain and Synchrony Assessed by Cardiac Magnetic Resonance Feature Tracking

Harrild

Marcus

Hasan

et al. 2013

Circ: Cardiovascular Interventions

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Background-Transcatheter pulmonary valve (TPV) replacement is an emerging therapy intended to restore pulmonary valve function in patients with right ventricular outflow tract conduit dysfunction; the impact of this technique on ventricular strain and synchrony is not known. Methods and Results-Cardiac magnetic resonance and ECG data acquired at 1 center as part of the US Melody TPV trial were analyzed. Biventricular strain and mechanical synchrony measurements were made based on short-axis and 4-chamber steady-state free precession images using feature tracking software. Post-versus pre-TPV replacement findings were compared for all patients (n=31) and subgroups with predominant pulmonary regurgitation (n=13) or stenosis (n=18). Most patients had tetralogy of Fallot (18/31). After TPV replacement, left ventricular (LV) circumferential strain increased for the whole cohort (P<0.001) and both subgroups (pulmonary regurgitation P=0.01; pulmonary stenosis P=0.02). LV longitudinal strain increased for the whole cohort (P=0.02) and pulmonary regurgitation subgroup (P=0.05); circumferential right ventricular strain increased for the pulmonary stenosis group only (P=0.05). LV longitudinal synchrony improved significantly in the pulmonary regurgitation group (maximum wall delay P=0.03; cross-correlation delay P=0.01). Electric measures of synchrony did not improve. Conclusions-In Harrild et al Impact of TPV Replacement 681are no reports of any kind of its impact on synchrony of the left ventricle (LV) or RV. The goal of the present study was to quantify the impact of TPV replacement on indices of RV and LV strain and synchrony in patients with dysfunctional RVOT conduits using high-quality CMR images. Methods Study DesignThis was a retrospective cohort study of patients undergoing placement of a Melody TPV in the setting of a dysfunctional RVOT conduit designed to investigate changes in ventricular mechanics based on CMR images before and after pulmonary valve implantation. This study was performed according to a protocol approved by the Committee for Clinical Investigations at Boston Children's Hospital, Boston, MA. PatientsPatients included in this study comprised a subset of the cohort enrolled at our center as part of the multicenter US Melody TPV investigational device exemption (IDE) trial. Briefly, the IDE trial was designed to investigate the safety, procedural success, and short-term effectiveness of Melody valve placement in patients with a biventricular circulation and a dysfunctional RVOT conduit. Study protocols and short-term outcomes have been previously reported. 4,5 As part of their participation in the trial, patients had clinical, ECG, and CMR data collected before and 6±2 months after TPV replacement. Patients were included in the present study if they had high-quality CMR images for analysis both pre-and post-TPV replacement performed between 2007 and 2010.Patients were first analyzed as an entire cohort, and then dichotomized into 2 groups: predominant pulmonary stenosis (PS; RVOT peak systolic e...

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“…We utilized strain and SR imaging so as to overcome this limitation by measuring the actual extent of stretching or contraction. Mueller et al (31) suggested that 2-D speckle tracking could provide information on the RV function but it required further investigation. More recently, in children, three-dimensional (3D) echocardiography has been found to have an excellent correlation with CMR in the assessment of the RV volumes and function.…”

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confidence: 99%

Doppler-derived strain and strain rate imaging assessment of right ventricular systolic function in adults late after tetralogy of Fallot repair: an observational study

Sadeghpour¹,

Kyavar²,

Madadi³

et al. 2013

Anadolu Kardiyol Derg

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Original Investigation Özgün Araşt›rma 536ÖZET Amaç: Fallot tetralojisi (TOF) siyanotik konjenital kalp hastalığının en sık görülen şeklidir. Günümüzde, TOF onarımı sonrası rezidüel pulmoner yetersizliği (PR) olan hastaların sayılarında artış ile karşı karşıyayız. Sağ ventrikül (RV) hacim ve fonksiyonu klinik karar vermeyi etkileyen en önemli faktörler arasındadır. Kardiyak manyetik rezonans (CMR) RV fonksiyonunun nicel değerlendirilmesi için altın standart yöntemdir; ancak, rutin klinik takip için pahalıdır ve bazen kontrendikedir. Biz TOF onarımı yapılan hastalarda CMR ile RV sistolik fonksiyonu değerlendirmesini Doppler kaynaklı strain (S) ve strain rate (SR) görüntülemesi ile karşılaştırmaya çalıştık. Yöntemler: Kesitsel bir çalışmada, TOF onarımından epey sonra şiddetli PR'li 70 hasta (22 kadın, ortalama yaş=22±4,9) değerlendirildi. RV serbest duvarının bazal, mid ve apikal segmentlerinde peak sistolik strain ve SR ölçülerek kısa-aks sine MR da ölçülen RV fonksiyonu ile karşılaştırıldı. RVEF ve S/SR arasındaki ilişkiler sıra lojistik regresyon modelleri ile incelendi.

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Assessment of interventricular and right-intraventricular dyssynchrony in patients with surgically repaired tetralogy of Fallot by two-dimensional speckle tracking

Abstract: Interventricular and right-intraventricular dyssynchrony are detectable in patients after TOF repair by 2D speckle tracking. Reduced RV myocardial deformation and QRS prolongation are the main factors associated with the observed dyssynchrony.

Cited by 33 publications

References 22 publications

Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot

Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot

Impact of Transcatheter Pulmonary Valve Replacement on Biventricular Strain and Synchrony Assessed by Cardiac Magnetic Resonance Feature Tracking

Doppler-derived strain and strain rate imaging assessment of right ventricular systolic function in adults late after tetralogy of Fallot repair: an observational study

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