Occult RV systolic dysfunction detected by CMR derived RV circumferential strain in patients with pectus excavatum

Abstract

AimsTo investigate the right ventricular (RV) strain in pectus excavatum (PE) patients using cardiac magnetic resonance tissue tracking (CMR TT).Materials and methodsFifty consecutive pectus excavatum patients, 10 to 32 years of age (mean age 15 ± 4 years), underwent routine cardiac magnetic resonance imaging (CMR) including standard measures of chest geometry and cardiac size and function. The control group consisted of 20 healthy patients with a mean age of 17 ± 5 years. RV longitudinal and circumferential strain magnitude was assessed by a dedicated RV tissue tracking software.ResultsFifty patients with images of sufficient quality were included in the analysis. The mean right and left ventricular ejection fractions were 55 ± 5% and 59 ± 4%. The RV global longitudinal strain was -21.88 ± 4.63%. The RV circumferential strain at base, mid-cavity and apex were -13.66 ± 3.09%, -11.31 ± 2.79%, -20.73 ± 3.45%, respectively. There was no statistically significant decrease in right ventricular or left ventricular ejection fraction between patients and controls (p > 0.05 for each). There was no significant difference in RV global longitudinal strain between two groups (-21.88 ± 4.63 versus -21.99 ± 3.58; p = 0.93). However, there was significant decrease in mid-cavity circumferential strain magnitude in pectus patients compared with controls (-11.31 ± 2.79 versus -16.19 ± 2.86; p < 0.001). PE patients had a significantly higher basal circumferential strain (-13.66 ± 3.09% versus -9.76 ± 1.79; p < 0.001) as well as apical circumferential strain (-20.73 ± 3.45% versus -12.07 ± 3.38) than control group.ConclusionMid-cavity circumferential strain but not longitudinal strain is reduced in pectus excavatum patients. Basal circumferential strain as well as apical circumferential strain were increased as compensatory mechanism for reduced mid-cavity circumferential strain. Further studies are needed to establish clinical significance of this finding.

False‐positive electrocardiographic changes during exercise test in a patient with pectus excavatum

“…A higher myocardial strain in the mid and apical portions of the ventricles has been interpreted as a possible compensation mechanism to enhance ventricular output against basal sternal compression. 20,21 Alternatively, myocardial strain impairment in PE subjects might reflect intraventricular dyssynchrony due to compressive phenomena within chest rather than a subclinical myocardial dysfunction. The blue zones that we observed in our patient at basal and mid-level in both 2D-STE derived bull's eye plots images suggested segmental paradoxical systolic expansion.…”

Research progress in the effects of pectus excavatum on cardiac functions

“…However, a disadvantage is that UCG is easily influenced by RV structure, retrosternal position, and motion complexity. 32 In 2016, Maagaard and Heiberg 33 searched three databases from 1972 to 2016 and 21 published studies that contained complete data were included, in which UCG data were compared before and after PE procedure to investigate cardiac function during rest and exercise. Among these included studies, Chao et al 34 and Sigalet et al 35 showed an increase in postoperative right ventricular output.…”

The hemodynamics during the Nuss procedure for repair of pectus excavatum

“…Вплив операції малоінвазивної корекції ЛДГК за Nuss на гемодинамічні показники та кардіальну функцію досить жваво обговорюється в літературі, хоч на сьогодні немає єдиного бачення даної проблеми. Деякі автори доводять позитивний вплив такої корекції на серцевий викид та ударний об'єм серця, тоді як інші заперечують такий ефект [5,9,10,14]. Ця проблема набуває актуальності ще і через те, що при відсутності покращення кардіореспіраторної функції внаслідок корекції ЛДГК операція вважається суто косметичною, та страхові компанії не компенсують її вартість пацієнтам [15].…”