No CrossRef data available.
Article contents
Exercise echocardiography demonstrates potential myocardial damage in patients with repaired tetralogy of Fallot using layer-specific strain analysis
Published online by Cambridge University Press: 04 May 2020
Abstract
Introduction:
Exercise stress echocardiography and layer-specific strains are emerging as important tools for cardiac assessment. This study was aimed to evaluate layer-specific strains and torsion parameters during exercise in order to investigate the characteristics of cardiac dysfunction in patients with repaired tetralogy of Fallot and to detect subclinical left ventricular dysfunction.
Materials and Methods:
Thirteen patients with repaired tetralogy of Fallot (median age, 17.3 [interquartile range, 14.5–22.9] years; 6 males) and 13 controls (median age, 28.5 [interquartile range, 27.6–31.6] years; 13 males) underwent echocardiography at rest and during supine exercise. Layer-specific longitudinal strain and circumferential strain of three myocardial layers (endocardium, midmyocardium, and epicardium), torsion, and untwisting rate were measured using two-dimensional speckle-tracking echocardiography.
Results:
Peak endocardial papillary circumferential strain (−21.1 ± 2.6% vs. −25.8 ± 3.8%, p = 0.007), midmyocardial apical circumferential strain (−11.1 ± 4.0% vs. −15.6 ± 3.2%, p = 0.001), epicardial apical circumferential strain (−11.1 ± 4.0% vs. −15.6 ± 3.2%, p = 0.021), and torsion (8.9 ± 6.0 vs. 14.9 ± 4.8 degree, p = 0.021) were significantly lower in the repaired tetralogy of Fallot group than in the control group during exercise, though no significant difference was found between patients and controls at rest.
Conclusions:
Analysis of layer-specific strains and torsion parameters during exercise could detect subclinical left ventricular dysfunction in patients with repaired tetralogy of Fallot, which might reflect potential myocardial damage, at a stage where these parameters have normal values at rest. This finding provides new insight into the mechanisms of cardiac dysfunction in patients with repaired tetralogy of Fallot.
Keywords
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2020. Published by Cambridge University Press
References
Apitz, C, Webb, GD, Redington, AN.Tetralogy of Fallot. Lancet 2009; 374: 1462–1471.CrossRefGoogle ScholarPubMed
Valente, AM, Gauvreau, K, Assent, GE, et al.Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart 2014; 100: 247–253.CrossRefGoogle ScholarPubMed
Nollert, G, Fischlein, T, Bouterwek, S, Bohmer, C, Klinner, W, Reichart, B.Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 1997; 30: 1374–1383.CrossRefGoogle ScholarPubMed
Babu-Narayam, SV, Kilner, PJ, Li, W, et al.Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of Fallot and its relationship to adverse markers of clinical outcome. Circulation 2006; 113: 405–413.CrossRefGoogle Scholar
Murphy, JG, Gersh, BJ, Mair, DD, et al.Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329: 593–599.CrossRefGoogle ScholarPubMed
Chiu, SN, Wang, JK, Chen, HC, et al.Long-term survival and unnatural deaths of patients with repaired tetralogy of Fallot in an Asian cohort. Circ Cardiovasc Qual Outcomes 2012; 5: 120–125.CrossRefGoogle Scholar
Davlouros, PA, Kilner, PJ, Harming, TS, et al.Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 2002; 40: 2044–2052.CrossRefGoogle ScholarPubMed
Ghai, A, Silversides, C, Harris, L, Webb, GD, Siu, SC, Therrien, J.Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot. J Am Coll Cardiol 2002; 40: 1675–1680.CrossRefGoogle ScholarPubMed
Knauth, AL, Gaudreau, 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.CrossRefGoogle ScholarPubMed
Diller, GP, Kempny, A, Liodakis, E, et al.Left ventricular longitudinal function predicts life-threatening ventricular arrhythmia and death in adults with repaired tetralogy of Fallot. Circulation 2012; 125: 2440–2446.CrossRefGoogle ScholarPubMed
Yamada, M, Takahashi, K, Kobayashi, M, et al.Mechanisms of left ventricular dysfunction assessed by layer-specific strain analysis in patients with repaired tetralogy of Fallot. Circ J 2017; 81: 846–854.CrossRefGoogle ScholarPubMed
Hamada, S, Schroeder, J, Hoffmann, R, et al.Prediction of outcomes in patients with chronic ischemic cardiomyopathy by layer-specific strain echocardiography: a proof of concept. J Am Soc Echocardiogr 2016; 29: 412–420.CrossRefGoogle Scholar
Yazaki, K, Takahashi, K, Shigemitsu, S, et al.In-depth insight into the mechanisms of cardiac dysfunction in patients with childhood cancer after anthracycline treatment using layer-specific strain analysis. Circ J 2018; 82: 715–723.CrossRefGoogle ScholarPubMed
Becker, M, Ocklenburg, C, Altiok, E, et al.Impact of infarct transmurality on layer-specific impairment of myocardial function: a myocardial deformation imaging study. Eur Heart J 2009; 30: 1467–1476.CrossRefGoogle ScholarPubMed
Mese, T, Guven, B, Yilmazer, MM, Demirol, M, Coban, S, Karadeniz, C.Global deformation parameters response to exercise in adolescents with repaired tetralogy of Fallot. Pediatr Cardiol 2017; 38: 362–367.CrossRefGoogle ScholarPubMed
Ait-Ali, L, Siciliano, V, Passino, C, et al.Role of stress echocardiography in operated fallot: feasibility and detection of right ventricular response. J Am Soc Echocardiogr 2014; 27: 1319–1328.CrossRefGoogle ScholarPubMed
Tan, YT, Wenzelburger, FW, Sanderson, JE, Leyva, F.Exercise-induced torsional dyssynchrony relates to impaired functional capacity in patients with heart failure and normal ejection fraction. Heart 2013; 99: 259–266.CrossRefGoogle ScholarPubMed
Zoghbi, WA, Enriquez-Sarano, M, Foster, E, et al.Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2013; 16: 777–802.CrossRefGoogle Scholar
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; 28: 1–39.CrossRefGoogle ScholarPubMed
D’Anna, C, Caputi, A, Natali, B, et al.Improving the role of echocardiography in studying the right ventricle of repaired tetralogy of Fallot patients: comparison with cardiac magnetic resonance. Int J Cardiovasc Imaging 2018; 34: 399–406.CrossRefGoogle ScholarPubMed
Leitman, M, Lysyansky, P, Sidenko, S, et al.Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr 2004; 17: 1021–1029.CrossRefGoogle ScholarPubMed
Takahashi, K, Naami, GA, Thompson, R, Inage, A, Mackie, AS, Smallhorn, JF.Normal rotational, torsion and untwisting data in children, adolescents and young adults. J Am Soc Echocardiogr 2010; 23: 286–293.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Roche, SL, Grosse-Wortmann, L, Friedberg, MK, Redington, AN, Stephens, D, Kantor, PF.Exercise echocardiography demonstrates biventricular systolic dysfunction and reveals decreased left ventricular contractile reserve in children after tetralogy of Fallot repair. J Am Soc Echocardiogr 2014; 3: 294–301.Google Scholar
Endoh, M.Force-frequency relationship in intact mammalian ventricular myocardium: physiological and pathophysiological relevance. Eur J Pharmacol 2004; 500: 73–86.CrossRefGoogle ScholarPubMed
Miura, T, Miyazaki, S, Guth, BD, Kambayashi, M, Ross, J.Influence of the force-frequency relation on left ventricular function during exercise in conscious dogs. Circulation 1992; 86: 563–571.CrossRefGoogle ScholarPubMed
Roche, SL, Grosse-Wortmann, L, Redington, AN, et al.Exercise induces biventricular mechanical dyssynchrony in children with repaired tetralogy of Fallot. Heart 2010; 96: 2010–2015.CrossRefGoogle ScholarPubMed
van der Hulst, AE, Delgado, V, Holman, ER, et al.Relation of left ventricular twist and global strain with right ventricular dysfunction in patients after operative “correction” of tetralogy of Fallot. Am J Cardiol 2010; 106: 723–729.CrossRefGoogle ScholarPubMed
Sheehan, FH, Ge, S, Vick, GW III, et al.Three-dimensional shape analysis of right ventricular remodeling in repaired tetralogy of Fallot. Am J Cardiol 2008; 101: 107–113.CrossRefGoogle ScholarPubMed
Enomoto, M, Ishizu, T, Seo, Y, et al.Subendocardial systolic dysfunction in asymptomatic normotensive diabetic patients. Circ J 2015; 79: 1749–1755.CrossRefGoogle ScholarPubMed
Orwat, S, Diller, GP, Kempny, A, et al.Myocardial deformation parameters predict outcome in patients with repaired tetralogy of Fallot. Heart 2016; 102: 209–215.CrossRefGoogle ScholarPubMed
Valente, AM, Gauvreau, K, Assenza, GE, et al.Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart 2013; 100: 247–253.CrossRefGoogle ScholarPubMed
Bouzas-Mosquera, A, Peteiro, J, Alvarez-Garcia, N, et al.Prognostic value of exercise echocardiography in patients with left bundle branch block. JACC Cardiovasc Imaging 2009; 2: 251–259.CrossRefGoogle ScholarPubMed
Bouzas-Mosquera, A, Peteiro, J, Alvarez-Garcia, N, et al.Prediction of mortality and major cardiac events by exercise echocardiography in patients with normal exercise electrocardiographic testing. J Am Coll Cardiol 2009; 53: 1981–1990.CrossRefGoogle ScholarPubMed
Bouzas-Mosquera, A, Peteiro, J, Broullon, FJ, et al.Prognostic value of exercise echocardiography in patients with atrial fibrillation. Eur J Echocardiogr 2010; 11: 346–351.CrossRefGoogle ScholarPubMed
Larsen, AH, Clemmensen, TS, Wiggers, H, Poulsen, SH.Left ventricular myocardial contractile reserve during exercise stress in healthy adults: a two-dimensional speckle-tracking echocardiographic study. J Am Soc Echocardiogr 2018; 31: 1116–1126.CrossRefGoogle ScholarPubMed
Arruda-Olson, AM, Juracan, EM, Mahoney, DW, McCully, RB, Roger, VL, Pellikka, PA.Prognostic value of exercise echocardiography in 5,798 patients: is there a gender difference? J Am Coll Cardiol 2002; 39: 625–631.CrossRefGoogle Scholar
Yazaki et al. supplementary material
Yazaki et al. supplementary material 1
Image
1.8 MB
Yazaki et al. supplementary material
Yazaki et al. supplementary material 2
File
67.6 KB
Yazaki et al. supplementary material
Yazaki et al. supplementary material 3
Image
1.8 MB