Left ventricular regional myocardial motion and twist function in repaired tetralogy of Fallot evaluated by magnetic resonance tissue phase mapping

Chang, Meng Chu; Wu, Ming Ting; Weng, Ken Pen; Su, Mao‐Yuan; Menza, Marius; Huang, Hung chieh; Peng, Hao‐Kai

doi:10.1007/s00330-017-4908-7

Cited by 12 publications

(22 citation statements)

References 37 publications

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“…Although we showed the decreased LV Vφ during systole in rTOF patients compared with that of normal controls, it should be noted that the assessment of circumferential myocardial motion was more difficult to identify compared with longitudinal and radial motion [5,24]. Further, because of the complicated and low diastolic myocardial motion velocity in rTOF patients, a simple measurement of Vφ might not be able to illustrate the difference between the groups.…”

Section: Plos Onementioning

confidence: 56%

“…Although PR can be tolerated for many years, chronic PR can lead to right ventricular (RV) volume overload, hypertrophy, fibrosis, myocardial injury, and heart failure overtime [1][2][3][4]. In addition, left ventricle (LV) remodeling is consequently affected [3,[5][6][7][8][9]. Therefore, surgical strategy has shifted from complete relief of pulmonary stenosis (PS) toward restrictive enlargement of the pulmonary annulus to maintain a certain pressure gradient between the RV and pulmonary artery (PA) trunk (PG RVPA ).…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac magnetic resonance imaging (MRI) is the standard method for comprehensive evaluation of rTOF patients [1][2][3]6,14]. MRI tissue phase mapping (TPM) has been approved for precise assessment of voxel-wise myocardial function for patients with a variety of heart diseases [15][16][17][18][19], and serves as a potential new diagnostic biomarker for rTOF patients [5]. As compared to speckle-tracking echocardiography and other MRI sequences for myocardial performance, such as myocardial tagging and feature tracking [20], TPM using a 2D acquisition has the advantages of less operator-dependence, high spatial resolution, and direct three-directional measurements of myocardial motion.…”

Section: Introductionmentioning

confidence: 99%

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Biventricular myocardial adaptation in patients with repaired tetralogy of Fallot: Mechanistic insights from magnetic resonance imaging tissue phase mapping

Chang

Weng

et al. 2020

PLoS ONE

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Background The myocardial adaptive mechanism in patients with repaired tetralogy of Fallot (rTOF) is less understood. We aimed to investigate biventricular myocardial adaptive remodeling in rTOF patients. Methods We recruited 32 rTOF patients and 38 age-and sex-matched normal controls. The pulmonary stenosis of rTOF patients was measured using catheterized pressure gradient between right ventricle (RV) and pulmonary artery (PG RVPA). rTOF patients with PG RVPA < 15 mmHg and �15 mmHg were classified as low pulmonary stenosis (rTOF low , n = 19) and high pulmonary stenosis (rTOF high , n = 13) subgroups, respectively. Magnetic resonance imaging tissue phase mapping was employed to evaluate the voxelwise biventricular myocardial motion in longitudinal (Vz), radial (Vr), and circumferential (Vφ) directions. Results The rTOF low subgroup presented higher pulmonary regurgitation fraction than rTOF high subgroup (p < 0.001). Compared with the normal group, only rTOF low subgroup presented a decreased RV ejection fraction (RVEF) (p < 0.05). The rTOF low subgroup showed decreased systolic and diastolic Vz in RV and LV, whereas rTOF high subgroup showed such change only in RV. In rTOF low subgroup, RVEF significantly correlated with RV systolic Vr (r = 0.56, p < 0.05), whereas LVEF correlated with LV systolic Vz (r = 0.51, p = 0.02).

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Section: Plos Onementioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biventricular myocardial adaptation in patients with repaired tetralogy of Fallot: Mechanistic insights from magnetic resonance imaging tissue phase mapping

Chang

Weng

et al. 2020

PLoS ONE

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“…The changes observed in myocardial microstructure of these CHD specimens may affect their electrophysiology. Electrical activation encounters less resistivity along the myocytes’ length [ 43 – 45 ]. There is a strong interdependence between epicardial fibre direction, conduction velocity, resistivity of the myocardium, and the potential field surrounding and generated by a wave of depolarization [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Ex vivo cardiovascular magnetic resonance diffusion weighted imaging in congenital heart disease, an insight into the microstructures of tetralogy of Fallot, biventricular and univentricular systemic right ventricle

Tous

Gentles

Young

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Purpose Common types of congenital heart disease exhibit a variety of structural and functional variations which may be accompanied by changes in the myocardial microstructure. We aimed to compare myocardial architecture from magnetic resonance diffusion tensor imaging (DTI) in preserved pathology specimens. Materials and methods Pathology specimens (n = 24) formalin-fixed for 40.8 ± 7.9 years comprised tetralogy of Fallot (TOF, n = 10), dextro-transposition of great arteries (D-TGA, n = 8) five with ventricular septal defect (VSD), systemic right ventricle (n = 4), situs inversus totalis (SIT, n = 1) and levo-TGA (L-TGA, n = 1). Specimens were imaged using a custom spin-echo sequence and segmented automatically according to tissue volume fraction. In each specimen T1, T2, fractional anisotropy, mean diffusivity, helix angle (HA) and sheet angle (E2A) were quantified. Pathologies were compared according to their HA gradient, HA asymmetry and E2A mean value in each myocardial segment (anterior, posterior, septal and lateral walls). Results TOF and D-TGA with VSD had decreased helix angle gradient by − 0.34°/% and remained symmetric in the septum in comparison to D-TGA without VSD. Helix angle range was decreased by 45°. It was associated with a decreased HA gradient in the right ventricular (RV) wall, i.e. predominant circumferential myocytes. The sheet angle in the septum of TOF was opposing those of the left ventricular (LV) free wall. Univentricular systemic RV had the lowest HA gradient (− 0.43°/%) and the highest HA asymmetry (75%). HA in SIT was linear, asymmetric, and reversed with a sign change at about 70% of the depth at mid-ventricle. In L-TGA with VSD, HA was asymmetric (90%) and its gradients were decreased in the septum, anterior and lateral wall. Conclusion The organization of the myocytes as determined by DTI differs between TOF, D-TGA, L-TGA, systemic RV and SIT specimens. These differences in cardiac structure may further enlighten our understanding of cardiac function in these diverse congenital heart diseases.

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“…The decreased systolic peak KE in the LV in patients is interesting as LV strain has been found to be decreased and regional myocardial velocities altered in rToF patients with preserved LVEF [ 26 , 27 ] and LV function is a strong predictor of outcome in these patients [ 28 ]. The difference in KE cannot be attributed to a decreased SV as the difference remains when indexing for SV.…”

Section: Discussionmentioning

confidence: 99%

Disturbed left and right ventricular kinetic energy in patients with repaired tetralogy of Fallot: pathophysiological insights using 4D-flow MRI

et al. 2018

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ObjectivesIndications for pulmonary valve replacement (PVR) in patients with pulmonary regurgitation (PR) after repaired tetralogy of Fallot (rToF) are debated. We aimed to compare right (RV) and left ventricular (LV) kinetic energy (KE) measured by 4D-flow magnetic resonance imaging (MRI) in patients to controls, to further understand the pathophysiological effects of PR.MethodsFifteen patients with rToF with PR > 20% and 14 controls underwent MRI. Ventricular volumes and KE were quantified from cine MRI and 4D-flow, respectively. Lagrangian coherent structures were used to discriminate KE in the PR. Restrictive RV physiology was defined as end-diastolic forward flow.ResultsLV systolic peak KE was lower in rToF, 2.8 ± 1.1 mJ, compared to healthy volunteers, 4.8 ± 1.1 mJ, p < 0.0001. RV diastolic peak KE was higher in rToF (7.7 ± 4.3 mJ vs 3.1 ± 1.3 mJ, p = 0.0001) and the difference most pronounced in patients with non-restrictive RV physiology. KE was primarily located in the PR volume at the time of diastolic peak KE, 64 ± 17%.ConclusionThis is the first study showing disturbed KE in patients with rToF and PR, in both the RV and LV. The role of KE as a potential early marker of ventricular dysfunction to guide intervention needs to be addressed in future studies.Key Points • Kinetic energy (KE) reflects ventricular performance • KE is a potential marker of ventricular dysfunction in Fallot patients • KE is disturbed in both ventricles in patients with tetralogy of Fallot • KE contributes to the understanding of the pathophysiology of pulmonary regurgitation • Lagrangian coherent structures enable differentiation of ventricular inflows Electronic supplementary materialThe online version of this article (10.1007/s00330-018-5385-3) contains supplementary material, which is available to authorized users.

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Left ventricular regional myocardial motion and twist function in repaired tetralogy of Fallot evaluated by magnetic resonance tissue phase mapping

Cited by 12 publications

References 37 publications

Biventricular myocardial adaptation in patients with repaired tetralogy of Fallot: Mechanistic insights from magnetic resonance imaging tissue phase mapping

Biventricular myocardial adaptation in patients with repaired tetralogy of Fallot: Mechanistic insights from magnetic resonance imaging tissue phase mapping

Ex vivo cardiovascular magnetic resonance diffusion weighted imaging in congenital heart disease, an insight into the microstructures of tetralogy of Fallot, biventricular and univentricular systemic right ventricle

Disturbed left and right ventricular kinetic energy in patients with repaired tetralogy of Fallot: pathophysiological insights using 4D-flow MRI

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