Assessment of right ventricular systolic function in children with repaired tetralogy of Fallot by multiple‐view from single acoustic window with speckle tracking echocardiography

Abstract

Background: Challenges remain in quantitative evaluation of right ventricular (RV) function by echocardiography. Multiple-view assessment is believed to provide a more comprehensive quantification of RV function than conventional single-view analysis. Peak systolic longitudinal RV strain (RVLS) measured by speckle tracking echocardiography (STE) has clinical and prognostic value. No study has investigated RV systolic function in the repaired tetralogy of Fallot (rTOF) using a standardized four-view iRotate model from one apical view. Herein, we examined the feasibility and accuracy of the four-view analysis from apical window in quantitation of RVLS among children with rTOF. Methods: Thirty-seven children with rTOF and 37 age-and gender-matched controls were prospectively enrolled. Tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (TDI-S ′ ) and fractional area change(FAC) were obtained. RVLS of four free-walls were analyzed by dedicated RV speckle tracking software. Echocardiographic parameters were compared with the right ventricular ejection fraction (RVEF) measured by the cardiac magnetic resonance (CMR) in children with rTOF. Results: Multi-view RVLS analysis from apical window was feasible in 35 children with rTOF and all the controls. Compared with age-and gender-matched controls, RVLS of the anterior, lateral, inferior-a, and inferior-b walls were significantly reduced in children with rTOF (P < 0.001). RVLS of the anterior, lateral, inferior-a, and inferiorb walls correlated well with CMR-RVEF in children with rTOF (r = −0.667, −0.743, −0.808, −0.695, P < 0.001). Conclusions:Multi-view analysis of RVLS from apical window can be applied to evaluate the RV function in children with rTOF. RVLS of the inferior wall-a in the aortic view is a novel and accurate indicator of RV function because of its good reproducibility and strong correlation with CMR-RVEF. K E Y W O R D SiRotate mode, multi-view, right ventricular function, tetralogy of Fallot

Speckle‐Tracking Analysis in Fetuses With Tetralogy of Fallot: Evaluation of Right and Left Ventricular Contractility and Left Ventricular Function

“…The measurements used in their study were similar to our approach and demonstrated the following sensitivity and specificity for predicting RV dysfunction: 1) RV fractional area change, 65.9%, 66.7%; and 2) tricuspid annular plane systolic excursion, 70.5%, 78.9% 11 . In 2019, Bao and colleagues evaluated the RV function in 37 children who had undergone surgical repair for TOF, with a mean age of 8 years 6 months 12 . They compared the ejection fraction using cardiac magnetic resonance imaging with ultrasound‐measured RV fractional area change, RV annular plane systolic excursion, and speckle‐tracking analysis of the RV free wall, and found significant correlations between magnetic resonance‐measured ejection fraction and ultrasound‐measured fractional area change and free wall speckle‐tracking strain analysis 12 …”

“…11 In 2019, Bao and colleagues evaluated the RV function in 37 children who had undergone surgical repair for TOF, with a mean age of 8 years 6 months. 12 They compared the ejection fraction using cardiac magnetic resonance imaging with ultrasound-measured RV fractional area change, RV annular plane systolic excursion, and speckle-tracking analysis of the RV free wall, and found significant correlations between magnetic resonance-measured ejection fraction and ultrasoundmeasured fractional area change and free wall speckle-tracking strain analysis. 12 Evaluation of ventricular function in fetuses with TOF has been limited.…”

“…12 They compared the ejection fraction using cardiac magnetic resonance imaging with ultrasound-measured RV fractional area change, RV annular plane systolic excursion, and speckle-tracking analysis of the RV free wall, and found significant correlations between magnetic resonance-measured ejection fraction and ultrasoundmeasured fractional area change and free wall speckle-tracking strain analysis. 12 Evaluation of ventricular function in fetuses with TOF has been limited. In a recent study by Song, using speckle tracking to measure global strain of the RV and LV, they found abnormal global strain for both ventricles.…”

Multi-plane echocardiographic assessment of right ventricular function in adults with repaired Tetralogy of Fallot

“…Since this RV wall is most proximal to the RVOT, the presence of a trans-annular patch from primary surgical reconstruction may explain reduced function in this region. This same multi-plane model has been applied in a cohort of children with repaired ToF [ 21 ], where conversely the lowest longitudinal strain values were reported in the two RV inferior walls. The inferior wall also correlated strongest with cardiac magnetic resonance (CMR) derived RVEF.…”

Ventricular function and dyssynchrony in children with a functional single right ventricle using real time three‐dimensional echocardiography after fontan operation

“…All MRI examinations were performed on a 1.5-T Intera Achieva scanner (Philips Medical Systems, Best, The Netherlands). 9 The MRI protocol included retrospectively-gated balanced steady-state free preces- One investigator performed the TomTec calculations twice over several weeks, blinded to the results of the first measurements. The two independent investigators who performed the TomTec measurements on separate days had no knowledge of the results obtained by the other observer.…”