Right and left ventricular interactions, strain, and remodeling in repaired pulmonary stenosis patients with preserved right ventricular ejection fraction: A cardiac magnetic resonance study

Abstract

BackgroundRight ventricular dilation and dysfunction is a common long‐term complication in patients with repaired pulmonary stenosis (rPS). Additionally, abnormal right and left ventricular interactions have been reported in right‐sided heart defect after intervention, including in pulmonary stenosis.PurposeTo analyze ventricular strain, remodeling, and left and right ventricular interactions in rPS patients with preserved right ventricular ejection fraction (RVEF) compared with healthy children using cardiac magnetic resonance.Study TypeA cross‐sectional study.PopulationIn all, 34 rPS patients and 10 healthy children volunteers (controls).Field Strength/Sequence3.0T/2D balanced steady‐state free precession (2D b‐SSFP) cine, late gadolinium enhancement (LGE), and 2D phase contrast (2D‐PC).AssessmentPulmonary regurgitation (PR) fractions of the main pulmonary artery, biventricular volumes, masses, function, and cardiac strain.Statistical TestsMann–Whitney U‐test, t‐test, Pearson correlation coefficients, Spearman's correlation coefficients, and intraclass correlation coefficients analysis were performed.ResultsFor group analysis, the right ventricular (RV) global circumferential strain and radial strain were significantly increased in patients when compared with controls (−13.57 ± 2.69 vs. −5.91 ± 3.16, P < 0.001; 25.31 ± 8.12 vs. 9.87 ± 5.32, P < 0.001, respectively). The fraction of PR displayed moderate correlation with right ventricular end‐diastolic volume index (RVEDVi) (r = 0.452, P = 0.022). RVEDVi and mass index were larger in patients vs. control (104.92 ± 27.46 vs. 85.15 ± 11.98, P = 0.016; 18.28 ± 4.95g/m2 vs. 11.67 ± 2.14 g/m2, P < 0.001, respectively). Patients presented with preserved left ventricular ejection function, but was lower than healthy controls (60.89% ± 4.89% vs. 65.95% ± 4.56%, P = 0.006). Regional circumferential strain of segment 3 of left ventricle (LV) were significantly decreased in patients (−7.79 ± 6.52 vs. −13.56 ± 3.22, P = 0.003).Data ConclusionCompensated increased RV strain, myocardial remodeling of RV, and adverse right and left ventricular interactions occur in rPS patients with preserved RVEF. The decreased interventricular septum strain may lead to impaired LV function due to RV dilation as a result of PR.Level of Evidence: 3Technical Efficacy Stage: 3J. Magn. Reson. Imaging 2020;52:129–138.

Left ventricular myocardial deformation assessment in asymptomatic patients with recently diagnosed sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis

“…Nevertheless, they described normal values for myocardial strain in healthy subjects (GLS mean value was − 19.1 ± 4.1%) from the analyses of images acquired in a 1.5 T scanner (Magnetom Avanto, Siemens, Erlangen, Germany), while, in our study (GLS mean value was − 14.2 ± 2.5%), subjects were examined using a 3.0 T MR Discovery 750 scanner (GE Healthcare, Chicago, USA). Similarly, Wang et al [ 43 ] used the same scanner as us and reported a GLS of − 13.55 ± 3.28% for healthy volunteers. So, normal values for GLS probably depend on many parameters, including the vendor and the software.…”

Characteristics of Right Ventricular Blood Flow in Patients With Chronic Thromboembolic Pulmonary Hypertension: An Analysis With 4-Dimensional Flow Cardiovascular Magnetic Resonance Imaging

“…The degree of RV structural remodeling and functional adaptability has been demonstrated to be important determinants of functional capacity and survival in patients with CTEPH. RVESVI, RVMI and strain et al have been used as RV remodeling markers ( 22 , 23 ). Our finding is that both RV PDF and PRVo correlated, but in opposite directions, with the conventional remodeling parameters such as RVEF, RVESVI, RVMI, and global longitudinal strain.…”

Development and validation of a predictive model for adverse left ventricular remodeling in NSTEMI patients after primary percutaneous coronary intervention

“…Extensive studies revealed that strain, correlating with IS and infarct mass, demonstrated independently prognostic values in AMI patients [ 16 , 30 – 34 ]. Interestingly, there has been no consensus on which parameter is more valuable in predicting ALVR.…”