Relation of Left Ventricular Twist and Global Strain with Right Ventricular Dysfunction in Patients After Operative “Correction” of Tetralogy of Fallot

Hulst, Annelies E. van der; Delgado, Victoria; Holman, Eduard R.; Kroft, Lucia J.M.; Roos, Albert de; Hazekamp, Mark G.; Blom, Nico A.; Bax, Jeroen J.; Roest, Arno A.W.

doi:10.1016/j.amjcard.2010.04.032

Cited by 55 publications

(49 citation statements)

References 22 publications

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“…Our findings in a large series of patients are in agreement with previous studies showing more pronounced dysfunction in the apical segments in the setting of PH 4–6 16. Interestingly, a pattern of RV dysfunction with predominant apical involvement also appears to occur in patients after operative ‘correction’ of tetralogy of Fallot 17. These findings are in contrast with those reported for acute pulmonary embolism, where severe hypokinesis of the mid-free wall with normal contraction of the apical segments (McConnell sign) has been described,18 although not consistently 19…”

Section: Discussionsupporting

confidence: 92%

Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

Fernández‐Friera

García‐Álvarez

Guzmán

et al. 2011

Heart

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Section: Discussionsupporting

confidence: 92%

Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

Fernández‐Friera

García‐Álvarez

Guzmán

et al. 2011

Heart

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“…Recently, van der Hulst et al have reported the reduction of LV systolic apical rotation and torsion in patients after repair of TOF. 16 The present study further demonstrates the impairment of the rate of systolic twisting and diastolic untwisting of the left ventricle, and their associations with RV volume overload and LV configuration.…”

Section: Discussionmentioning

confidence: 86%

“…Indeed, apical RV strain has been shown recently to correlate with apical LV rotation. 16 In contrast, volume overloading of the right ventricle in adults with secundum atrial septal defect has been shown to be associated with reduced LV torsion, due primarily to impaired basal rotation. 20 Loading conditions and abnormal myocardial deformation might possibly also influence LV torsional mechanics.…”

Section: Discussionmentioning

confidence: 99%

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Cheung

Wong

Liang

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp hile right ventricular (RV) dysfunction has been the main concern in patients after repair of tetralogy of Fallot (TOF), 1-3 the importance of left ventricular (LV) dysfunction as a risk factor of long-term adverse outcomes is increasingly acknowledged. 1,4,5 Dysfunction of the left ventricle is characterized by reduced ejection fraction, 1,4 altered systolic myocardial deformation, 6,7 and systolic mechanical dyssynchrony. 1,7,8 These LV functional abnormalities have been attributed to suboptimal ventricular-ventricular interaction, 1,4 although the nature of this interaction remains to be defined.Assessment of cardiac mechanics has extended from evaluation of linear to torsional deformation, which might provide new mechanistic insights. Twisting motion of the left ventricle during the ejection phase is important in the Frank-Starling mechanism, 9 while untwisting contributes to LV diastolic relaxation and early diastolic filling. 10 Interaction between LV subendocardial and subepicardial helical myocardial fibres has been proposed to explain the phenomenon of torsional deformation. 11 Alteration of septal geometry and changes in LV shape due to volume overloading of the right ventricle might potentially distort this interaction and impair torsional deformation. In the present study, we tested the hypothesis that alteration of LV torsional mechanics occurs in postoperative TOF patients and is associated with RV volume overload and changes in LV configuration. Methods SubjectsFifty-five patients who had undergone surgical repair of TOF with transannular patch enlargement of the RV outflow were recruited consecutively from the cardiac clinic of Queen Mary Hospital. From the case records, the following data were retrieved: age at operation, types of surgical procedure, and duration of follow up since total repair. Twenty-seven healthy subjects, including those followed up for non-specific chest pain and palpitation but without documented cardiac arrhythmias and healthy siblings, were recruited as controls. The weight and height of all subjects were measured and the body surface area was calculated accordingly. The Institutional Review Board approved the study and all of the subjects gave

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“…9,14,15,19,20,23,24,26-28,30,33,38,39,41,44-47,49 The normal mean values of GLS varied from -16.7% to -23.6% (mean -20.2%, 95% CI -19.5% to -20.8%), (Figure 2a). Between-study heterogeneity was evidenced by a Cochran's Q statistic of 561 (P < 0.0001) and inconsistency by an I 2 value of 95.5%.…”

Section: Resultsmentioning

confidence: 99%

“…11,15,16,19,20,23,25,26,28,29,33,41-43,46 The patient characteristics of the included studies are listed in Table 1. The echocardiographic variables included from the studies are listed in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

267

215

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Background The establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE) derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims were to perform a meta-analysis of normal ranges of LV global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS) measurements derived by 2DSTE in children and identify confounding factors that may contribute to variances in reported measures. Methods A systematic review was launched in Medline, Embase, Scopus, CINAHL, and Cochrane. Search hedges were created to cover the concepts of pediatrics, speckle-tracking echocardiography, and left heart ventricle. Two investigators independently identified and included studies if they reported the 2DSTE derived LV GLS, GCS or GRS. The weighted mean was estimated by using random-effects with 95% confidence interval (CI), heterogeneity was assessed by the Cochran's Q statistic and the inconsistency index (I2) and publication was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a meta-regression. Results The search identified 2325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean -20.2%, 95% CI -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean -22.3%, 95% CI -19.9% to -24.6%) and GRS, varied from 33.9% to 54.5 % (mean 45.2 95% CI 38.3 to 51.7). 26 studies reported LS only from the apical 4-chamber view with a mean of -20.4%, (95% CI -19.8% to -21.7%). 23 studies reported CS (mean, -20.3%, 95% CI -19.4% to -21.2%) and RS (mean, 46.7%, 95% CI 42.3% to 51.1%) from the short axis view at the mid-ventricular level. A significant apex-to-base segmental longitudinal strain (SLS) gradient (P < .01) was observed in the LV free wall. There was significant between- study heterogeneity and inconsistency (I2 > 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, FR/HR ratio tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. These metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). Conclusions This study defined reference values of 2DSTE derived LV strain in children on the basis of a meta-analysis. In healthy children, the mean LV global longitudinal strain value is -20.2%, (95% CI -19.5% to -20.8%), mean global circumferential strain -22.3%, (95% CI -19.9% to -24.6%), and mean global radial strain is 45.2%, (95% CI 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturations. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor para...

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Relation of Left Ventricular Twist and Global Strain with Right Ventricular Dysfunction in Patients After Operative “Correction” of Tetralogy of Fallot

Cited by 55 publications

References 22 publications

Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

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