Is MRI the Preferred Method for Evaluating Right Ventricular Size and Function in Patients With Congenital Heart Disease?

Geva, Tal

doi:10.1161/circimaging.113.000553

Cited by 116 publications

(54 citation statements)

References 49 publications

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“…However, the complex geometry of the RV poses a significant limitation to the reliable quantitation of RV volumes and ejection fraction (RVEF) using 2-dimensional transthoracic echocardiography. Although cardiac magnetic resonance (CMR) imaging is the gold standard for the evaluation of RV volumes and RVEF, 8,9 factors such as cost, portability, time consumption, and contraindications hinder its routine use in every patient. Three-dimensional transthoracic echocardiography (3DTTE) has the advantage of full-volume acquisition of the entire right ventricle, which may overcome the technical and clinical limitations of 2-dimensional transthoracic echocardiography.…”

mentioning

confidence: 99%

Prognostic Value of Right Ventricular Ejection Fraction Assessed by Transthoracic 3D Echocardiography

Nagata

Kado

et al. 2017

Circ: Cardiovascular Imaging

147

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R ight ventricular (RV) function is closely coupled with subsequent morbidity and mortality in patients with diseases affecting the right heart chambers. [1][2][3][4][5][6][7] The most common cause of RV dysfunction is chronic left-sided heart failure. Complex factors such as pulmonary hypertension, intrinsic myocardial involvement, ventricular interdependence, and myocardial ischemia lead to RV dysfunction. 1 Therefore, assessment of RV function is clinically important in almost all patients with heart disease. However, the complex geometry of the RV poses a significant limitation to the reliable quantitation of RV volumes and ejection fraction (RVEF) using 2-dimensional transthoracic echocardiography. Although cardiac magnetic resonance (CMR) imaging is the gold standard for the evaluation of RV volumes and RVEF, 8,9 factors such as cost, portability, time consumption, and contraindications hinder its routine use in every patient. Three-dimensional transthoracic echocardiography (3DTTE) has the advantage of full-volume acquisition of the entire right ventricle, which may overcome the technical and clinical limitations of 2-dimensional transthoracic echocardiography. [10][11][12] Recent studies have validated the accuracy of 3DTTE-determined RV volumes and RVEF against CMR 13,14 and determined the reference values of RV volumes and RVEF in healthy subjects. 15,16 However, the prognostic value of RVEF is largely unknown. We hypothesized that RVEF assessed by 3DTTE (3DRVEF) would offer incremental value over left ventricular (LV) functional parameters for predicting future cardiac events. See Editorial by Fernández-Golfín and Zamorano See Clinical PerspectiveAccordingly, the aims of this study were (1) to validate the accuracy of 3DTTE-determined RV volumes and RVEF against CMR reference and (2) to evaluate the prognostic value of 3DRVEF to predict future cardiac death and major adverse cardiac events (MACEs) in a large number of patients.Background-Cardiac magnetic resonance is the gold standard for the evaluation of right ventricular (RV) volumes, but it is impractical to perform in every patient. Although reference values of RV volumes and RV ejection fraction by 3D transthoracic echocardiography (3DTTE) have been established, their prognostic values have not been elucidated yet. We hypothesized that RV ejection fraction measured by 3DTTE (3DRVEF) predicts future cardiovascular events. Methods and Results-In protocol 1, we determined the accuracy of RV volumes and RV ejection fraction measurements by 3DTTE against cardiac magnetic resonance in 60 subjects. In protocol 2, 3DRVEF was measured in 446 patients with various cardiovascular diseases. Study subjects were followed up to record cardiac death and major adverse cardiovascular events. In protocol 1, 3DTTE-determined RV end-diastolic volume, end-systolic volume, and RV ejection fraction had good correlations to those by cardiac magnetic resonance (r=0.74-0.90). In protocol 2, 38 cardiac deaths and 88 major adverse cardiovascular events occurred during a med...

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confidence: 99%

Prognostic Value of Right Ventricular Ejection Fraction Assessed by Transthoracic 3D Echocardiography

Nagata

Kado

et al. 2017

Circ: Cardiovascular Imaging

147

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“…Patient-tailored, evidence-based strategies for determining the threshold for PVR are maturing in sophistication and point to earlier intervention. 12 The Rotterdam group and others show self-perceived health status among TOF patients to be generally good, despite declining cardiac function.…”

Section: Circulationmentioning

confidence: 95%

“…11 Reasoned thresholds for PVR based on QRS prolongation have moved from 180 toward 140 milliseconds. 12 Functional recovery of the RV after PVR is less likely if the preoperative RV end-diastolic volume is >170 mL/m 2 , and that threshold is moving toward 150 mL/m 2 . 12 Exercise criteria, RV mass-to-volume ratio, and other metrics support lowering the threshold.…”

Section: Circulationmentioning

confidence: 99%

“…12 Functional recovery of the RV after PVR is less likely if the preoperative RV end-diastolic volume is >170 mL/m 2 , and that threshold is moving toward 150 mL/m 2 . 12 Exercise criteria, RV mass-to-volume ratio, and other metrics support lowering the threshold. 13 The Rotterdam data report results of a conservative strategy, with PVR reserved for those with symptoms.…”

Section: Circulationmentioning

confidence: 99%

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Fourth Decade After Repair of Tetralogy of Fallot

Bichell

2014

Circulation

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“…For these reasons cardiac magnetic resonance (CMR) is considered the gold-standard tool to assess RV anatomy and function in both acquired and congenital heart disease (CHD), when accuracy matters. 8 In 2010, the American Society of Echocardiography developed guidelines for quantitative assessment of RV function in adults, providing standardized measures for serial follow-up and aiming to improve the accuracy and reproducibility of echocardiographic imaging. 9 Strain and strain rate measurements obtained by tissue Doppler imaging (TDI) and two-dimensional (2D) speckle-tracking echocardiography (STE) have emerged in the last decade as tools to assess RV myocardial deformation and to detect subclinical myocardial dysfunction in patients with normal conventional ventricular function indices, and before RV ejection fraction decreases.…”

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confidence: 99%

Right ventricular speckle tracking echocardiography: A new tool for decision-making after surgical repair of tetralogy of Fallot?

Pinto

2017

Revista Portuguesa de Cardiologia

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Surgical correction of tetralogy of Fallot (TOF) has evolved in recent years from correction after childhood to early surgery, even in the neonatal period. Before and after correction the right ventricle is mainly affected, experiencing persistent pressure and/or volume overload and intrinsic or acquired right ventricular (RV) myopathy. On follow-up, these patients can present RV enlargement, dysfunction and fibrosis, all with significant clinical impact, such as exercise limitation, RV failure and a substrate for lethal ventricular arrhythmias and sudden cardiac death (SCD).1 A combination of varying degrees of long-standing pulmonary regurgitation and residual stenosis has been identified as a major issue after TOF correction that over time triggers RV remodeling, affecting ventricular synchrony and coupling and also impairing left ventricular function. 2In long-term follow-up, arrhythmias are a common problem in more than 30% of patients with repaired TOF, sometimes causing adverse outcomes and even SCD, which has an estimated incidence of 0.2% per year in these DOI patients. There is thus a need for accurate risk predictors in the follow-up of TOF patients. 3 Various clinical factors have been investigated as predictors of late arrhythmic events, but they still lack strong positive predictive accuracy. This situation has prompted considerable changes in the surgical approach to TOF in recent decades. The current approach favors repair at a younger age (<2 years), efforts to preserve pulmonary valve competence and to avoid ventriculotomy, and extensive removal of infundibular muscle.4 Nevertheless, definitive evidence on the optimal surgical strategies to protect RV function and reduce arrhythmias and risk of SCD is lacking. 5One of the hot topics in TOF is active long-term preservation of RV function. Ways to prevent significant pulmonary regurgitation and to avoid RV dilatation remain the main target, but the optimal timing for therapeutic intervention remains uncertain, although there is a trend towards early reintervention and acceptance of certain approaches is emerging. 6,7 Careful imaging surveillance of RV size and function is essential to determine optimal timing of additional corrective interventions.7 Which imaging parameters are the most reliable for decision-making in clinical assessment remains a crucial question.Although there have been many advances in noninvasive RV imaging during the past decade, echocardiography http://dx.doi.org/10.1016/j.repc.2016.11.001 0870-2551/© 2016 Published by Elsevier España, S.L.U. on behalf of Sociedade Portuguesa de Cardiologia. Documento descargado de http://www.elsevier.pt el 09/01/2017. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.

show abstract

Is MRI the Preferred Method for Evaluating Right Ventricular Size and Function in Patients With Congenital Heart Disease?

Cited by 116 publications

References 49 publications

Prognostic Value of Right Ventricular Ejection Fraction Assessed by Transthoracic 3D Echocardiography

Prognostic Value of Right Ventricular Ejection Fraction Assessed by Transthoracic 3D Echocardiography

Fourth Decade After Repair of Tetralogy of Fallot

Right ventricular speckle tracking echocardiography: A new tool for decision-making after surgical repair of tetralogy of Fallot?

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