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The value of right ventricular longitudinal strain in the evaluation of adult patients with repaired tetralogy of Fallot: a new tool for a contemporary challenge

Published online by Cambridge University Press:  26 May 2016

Luís Almeida-Morais ,
Tiago Pereira-da-Silva ,
Luísa Branco ,
Ana T. Timóteo ,
Ana Agapito ,
Lídia de Sousa ,
José A. Oliveira ,
Boban Thomas ,
Nuno Jalles-Tavares  and
Rui Soares
...Show all authors
Luís Almeida-Morais*
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Tiago Pereira-da-Silva
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Luísa Branco
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Ana T. Timóteo
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Ana Agapito
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Lídia de Sousa
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
José A. Oliveira
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Boban Thomas
Affiliation:
MRI Caselas, Lisbon, Portugal
Nuno Jalles-Tavares
Affiliation:
MRI Caselas, Lisbon, Portugal
Rui Soares
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Ana Galrinho
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
Rui Cruz-Ferreira
Affiliation:
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
*
Correspondence to: L. Almeida-Morais, MD, Department of Cardiology, Hospital de Santa Marta, Rua de Santa Marta, no. 50, 1169-024 Lisbon, Portugal. Tel: +351 21 359 4000; Fax: +351 213 144 916; E-mail: lmmorais88@gmail.com
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Abstract

Objective

The role of right ventricular longitudinal strain for assessing patients with repaired tetralogy of Fallot is not fully understood. In this study, we aimed to evaluate its relation with other structural and functional parameters in these patients.

Methods

Patients followed-up in a grown-up CHD unit, assessed by transthoracic echocardiography, cardiac MRI, and treadmill exercise testing, were retrospectively evaluated. Right ventricular size and function and pulmonary regurgitation severity were assessed by echocardiography and MRI. Right ventricular longitudinal strain was evaluated in the four-chamber view using the standard semiautomatic method.

Results

In total, 42 patients were included (61% male, 32±8 years). The mean right ventricular longitudinal strain was −16.2±3.7%, and the right ventricular ejection fraction, measured by MRI, was 42.9±7.2%. Longitudinal strain showed linear correlation with tricuspid annular systolic excursion (r=−0.40) and right ventricular ejection fraction (r=−0.45) (all p<0.05), which in turn showed linear correlation with right ventricular fractional area change (r=0.50), pulmonary regurgitation colour length (r=0.35), right ventricular end-systolic volume (r=−0.60), and left ventricular ejection fraction (r=0.36) (all p<0.05). Longitudinal strain (β=−0.72, 95% confidence interval −1.41, −0.15) and left ventricular ejection fraction (β=0.39, 95% confidence interval 0.11, 0.67) were independently associated with right ventricular ejection fraction. The best threshold of longitudinal strain for predicting a right ventricular ejection fraction of <40% was −17.0%.

Conclusions

Right ventricular longitudinal strain is a powerful method for evaluating patients with tetralogy of Fallot. It correlated with echocardiographic right ventricular function parameters and was independently associated with right ventricular ejection fraction derived by MRI.

Keywords

Longitudinal strainright ventricular functiontetralogy of Fallot2D-speckle tracking
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 498 - 506
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Copyright
© Cambridge University Press 2016 

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References

1. Bertranou, EG, Blackstone, EH, Hazelrig, JB, Turner, ME, Kirklin, JW. Life expectancy without surgery in tetralogy of Fallot. Am J Cardiol 1978; 42: 458–466.Google Scholar
2. Cuypers, JAAE, Menting, ME, Konings, EEM, et al. Unnatural history of tetralogy of Fallot: prospective follow-up of 40 years after surgical correction. Circulation 2014; 130: 1944–1953.Google Scholar
3. Pillutla, P, Shetty, KD, Foster, E. Mortality associated with adult congenital heart disease: trends in the US population from 1979 to 2005. Am Heart J 2009; 158: 874–879.Google Scholar
4. Frigiola, A, Redington, AN, Cullen, S, Vogel, M. Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. Circulation 2004; 110 (Suppl 1): II153–II157.Google Scholar
5. Marie, PY, Marçon, F, Brunotte, F, et al. Right ventricular overload and induced sustained ventricular tachycardia in operatively ‘repaired’ tetralogy of Fallot. Am J Cardiol 1992; 69: 785–789.Google Scholar
6. Friedberg, MK, Fernandes, FP, Roche, SL, et al. Relation of right ventricular mechanics to exercise tolerance in children after tetralogy of Fallot repair. Am Heart J 2013; 165: 551–557.Google Scholar
7. Endorsed by the Association for European Paediatric Cardiology (AEPC), Authors/Task Force Members, Baumgartner, H, Bonhoeffer, P, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010): the task force on the management of grown-up congenital heart disease of the european society of cardiology (ESC). Eur Heart J 2010; 31: 2915–2957.Google Scholar
8. Kilner, PJ, Geva, T, Kaemmerer, H, Trindade, PT, Schwitter, J, Webb, GD. Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the european society of cardiology. Eur Heart J 2010 Apr; 31: 794–805.Google Scholar
9. Knauth, AL, Gauvreau, K, Powell, AJ, et al. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 2008; 94: 211–216.Google Scholar
10. Bernard, Y, Morel, M, Descotes-Genon, V, Jehl, J, Meneveau, N, Schiele, F. Value of speckle tracking for the assessment of right ventricular function in patients operated on for tetralogy of Fallot. comparison with magnetic resonance imaging. Echocardiogr Mt Kisco N 2014; 31: 474–482.Google Scholar
11. Rudski, LG, Lai, WW, Afilalo, J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr 2010; 23: 685–713; quiz 786–788.Google Scholar
12. Benyounes, N, Lang, S, Soulat-Dufour, L, et al. Can global longitudinal strain predict reduced left ventricular ejection fraction in daily echocardiographic practice? Arch Cardiovasc Dis 2015; 108: 50–56.Google Scholar
13. Nahum, J, Bensaid, A, Dussault, C, et al. Impact of longitudinal myocardial deformation on the prognosis of chronic heart failure patients. Circ Cardiovasc Imaging 2010; 3: 249–256.Google Scholar
14. Fine, NM, Chen, L, Bastiansen, PM, et al. Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging 2013; 6: 711–721.Google Scholar
15. Luna, AB de. Clinical Electrocardiography: A Textbook, 4th edn. John Wiley & Sons, Oxford, United Kindgom, 2012, 571 pp.Google Scholar
16. Lang, RM, Badano, LP, Mor-Avi, V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015 Jan; 28: 1–39.e14.Google Scholar
17. Kawel-Boehm, N, Maceira, A, Valsangiacomo-Buechel, ER, et al. Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson Off J Soc Cardiovasc Magn Reson 2015; 17: 29.Google Scholar
18. Guazzi, M, Adams, V, Conraads, V, et al. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2012; 126: 2261–2274.Google Scholar
19. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e143–e263.Google Scholar
20. Amundsen, BH, Helle-Valle, T, Edvardsen, T, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiographyvalidation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 2006; 47: 789–793.Google Scholar
21. Cho, G-Y, Marwick, TH, Kim, H-S, Kim, M-K, Hong, K-S, Oh, D-J. Global 2-dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol 2009; 54: 618–624.Google Scholar
22. Stanton, T, Leano, R, Marwick, TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging 2009; 2: 356–364.Google Scholar
23. Jategaonkar, SR, Scholtz, W, Butz, T, Bogunovic, N, Faber, L, Horstkotte, D. Two-dimensional strain and strain rate imaging of the right ventricle in adult patients before and after percutaneous closure of atrial septal defects. Eur J Echocardiogr J Work Group Echocardiogr Eur Soc Cardiol 2009; 10: 499–502.Google Scholar
24. Sugiura, E, Dohi, K, Onishi, K, et al. Reversible right ventricular regional non-uniformity quantified by speckle-tracking strain imaging in patients with acute pulmonary thromboembolism. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr 2009; 22: 1353–1359.Google Scholar
25. Pirat, B, McCulloch, ML, Zoghbi, WA. Evaluation of global and regional right ventricular systolic function in patients with pulmonary hypertension using a novel speckle tracking method. Am J Cardiol 2006; 98: 699–704.Google Scholar
26. Wald, RM, Haber, I, Wald, R, Valente, AM, Powell, AJ, Geva, T. Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot. Circulation 2009; 119: 1370–1377.Google Scholar
27. Meijboom, F, Szatmari, A, Deckers, JW, et al. Cardiac status and health-related quality of life in the long term after surgical repair of tetralogy of Fallot in infancy and childhood. J Thorac Cardiovasc Surg 1995; 110 (Pt 1): 883–891.Google Scholar
28. Gatzoulis, MA, Balaji, S, Webber, SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975–981.Google Scholar
29. Ramos, R, Branco, L, Agapito, A, et al. Usefulness of tissue doppler imaging to predict arrhythmic events in adults with repaired tetralogy of Fallot. Rev Port Cardiol Orgão Of Soc Port Cardiol Port J Cardiol Off J Port Soc Cardiol 2010; 29: 1145–1161.Google Scholar
30. Koestenberger, M, Ravekes, W, Everett, AD, et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr 2009; 22: 715–719.Google Scholar
31. Khoo, NS, Young, A, Occleshaw, C, Cowan, B, Zeng, ISL, Gentles, TL. Assessments of right ventricular volume and function using three-dimensional echocardiography in older children and adults with congenital heart disease: comparison with cardiac magnetic resonance imaging. J Am Soc Echocardiogr 2009; 22: 1279–1288.Google Scholar
32. Fukuda, Y, Tanaka, H, Sugiyama, D, et al. Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr 2011; 24: 1101–1108.Google Scholar
33. Geva, T, Sandweiss, BM, Gauvreau, K, Lock, JE, Powell, AJ. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 2004; 43: 1068–1074.Google Scholar
34. Piazza, L, Chessa, M, Giamberti, A, et al. Timing of pulmonary valve replacement after tetralogy of Fallot repair. Expert Rev Cardiovasc Ther 2012; 10: 917–923.Google Scholar
35. Li, Y, Xie, M, Wang, X, et al. Evaluation of right ventricular global longitudinal function in patients with tetralogy of fallot by two-dimensional ultrasound speckle tracking imaging. J Huazhong Univ Sci Technol Med Sci Hua Zhong Ke Ji Xue Xue Bao Yi Xue Ying Wen Ban Huazhong Keji Daxue Xuebao Yixue Yingdewen Ban 2010; 30: 126–131.Google Scholar