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

Abstract

BackgroundIn 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.MethodsThirty-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.ResultsFollowing 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.ConclusionsSurgical 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.

CMR feature tracking left ventricular strain-rate predicts ventricular tachyarrhythmia, but not deterioration of ventricular function in patients with repaired tetralogy of Fallot

“…Mechanical interventricular coupling could potentially play a role in the affected LV systolic function, as RV dilatation or RV pressure load leads to decreased LV function [30][31][32]. Furthermore, in rTOF patients, reduced RV dilatation after valve replacement resulted in improved LV strain, whereas RV strain was unaltered [33]. The present study supports the increasing attention for the LV in right-sided heart diseases.…”

Impact of pulmonary valve replacement on left ventricular rotational mechanics in repaired tetralogy of Fallot

“…Impaired LV function has been shown to be an important predictor of adverse clinical outcome in rTOF [ 6 , 14 ]; however, the mechanism for LV dysfunction has not been well characterized. There has been an increasing interest on using advanced non-invasive measures of LV myocardial mechanics to gain insight into the underlying causes of LV dysfunction [ 21 , 22 , 26 , 40 ]. The focus has primarily been on strain parameters, but rotation is also an essential part of the normal mechanics of the LV.…”

Cardiac magnetic resonance feature tracking of the right ventricle in convalescent Kawasaki disease in a large single center

“…For echocardiography, currently, the qualitative evaluation of RV cardiac function is a diagnostic challenge due to the unusual shape and uneven contractility pattern 34 . CMR has been the gold standard method in RV function evaluation, and FT‐CMR can add value for RV contractility abnormalities 34‐38 . Reproducible and repeatable quantification of RV strain indices are also vital to monitor patients 39 .…”