TY - JOUR
T1 - Impaired left ventricular myocardial mechanics and their relation to pulmonary regurgitation, right ventricular enlargement and exercise capacity in asymptomatic children after repair of tetralogy of fallot
AU - Fernandes, Fernanda P.
AU - Manlhiot, Cedric
AU - Roche, Susan L.
AU - Grosse-Wortmann, Lars
AU - Slorach, Cameron
AU - McCrindle, Brian W.
AU - Mertens, Luc
AU - Kantor, Paul F.
AU - Friedberg, Mark K.
N1 - Funding Information:
This research was supported by a grant from the SickKids Foundation (Toronto, ON, Canada) and the Canadian Institutes of Health Research (Ottawa, ON, Canada).
Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/5
Y1 - 2012/5
N2 - Background: Left ventricular (LV) dysfunction is common in adults late after repair of tetralogy of Fallot (TOF). The early detection of myocardial dysfunction may be important, but LV myocardial strain and dyssynchrony are not well studied in children with TOF. The objective of this study was to investigate LV strain and dyssynchrony in asymptomatic children and adolescents after contemporary repair of TOF. The hypothesis was that impaired LV myocardial mechanics are related to pulmonary regurgitation, right ventricular (RV) enlargement, and exercise capacity. Methods: Children and adolescents were prospectively studied after TOF repair. LV regional strain and dyssynchrony were assessed using two-dimensional speckle-tracking echocardiography. Ventricular volumes, ejection fraction, and pulmonary regurgitation were assessed using magnetic resonance imaging. Exercise capacity was determined using metabolic exercise testing. Results: One hundred twenty-four subjects (53 patients with TOF and 71 controls) were studied. Regional circumferential (e.g., basal lateral wall, -15.0 ± 7.0% vs -19.0 ± 7.0%, P =.02) and radial (e.g., basal posterior wall, 32.0 ± 18.0% vs 48.0 ± 21.0%, P <.001) LV strain and longitudinal septal strain (-18.5 ± 3.5% vs -20.2 ± 2.8%, P =.01) were significantly reduced in patients with TOF compared with controls. LV mechanical dyssynchrony indices were not significantly different between groups (e.g., standard deviation of time to peak circumferential strain, 52.5 ± 40.4 vs 50.5 ± 27.1 msec, P =.81). Higher pulmonary regurgitation volume and larger RV end-diastolic volume were associated with decreased LV radial strain (P =.09). There was no association between LV longitudinal, radial, or circumferential dyssynchrony and indexed pulmonary regurgitation flow volume, RV end-diastolic volume, or RV ejection fraction. Conclusions: LV circumferential and radial strain are significantly reduced in children and adolescents after TOF repair and are associated with pulmonary regurgitation and RV dilatation. Resting LV mechanical dyssynchrony does not appear to contribute to early impaired LV strain in this population.
AB - Background: Left ventricular (LV) dysfunction is common in adults late after repair of tetralogy of Fallot (TOF). The early detection of myocardial dysfunction may be important, but LV myocardial strain and dyssynchrony are not well studied in children with TOF. The objective of this study was to investigate LV strain and dyssynchrony in asymptomatic children and adolescents after contemporary repair of TOF. The hypothesis was that impaired LV myocardial mechanics are related to pulmonary regurgitation, right ventricular (RV) enlargement, and exercise capacity. Methods: Children and adolescents were prospectively studied after TOF repair. LV regional strain and dyssynchrony were assessed using two-dimensional speckle-tracking echocardiography. Ventricular volumes, ejection fraction, and pulmonary regurgitation were assessed using magnetic resonance imaging. Exercise capacity was determined using metabolic exercise testing. Results: One hundred twenty-four subjects (53 patients with TOF and 71 controls) were studied. Regional circumferential (e.g., basal lateral wall, -15.0 ± 7.0% vs -19.0 ± 7.0%, P =.02) and radial (e.g., basal posterior wall, 32.0 ± 18.0% vs 48.0 ± 21.0%, P <.001) LV strain and longitudinal septal strain (-18.5 ± 3.5% vs -20.2 ± 2.8%, P =.01) were significantly reduced in patients with TOF compared with controls. LV mechanical dyssynchrony indices were not significantly different between groups (e.g., standard deviation of time to peak circumferential strain, 52.5 ± 40.4 vs 50.5 ± 27.1 msec, P =.81). Higher pulmonary regurgitation volume and larger RV end-diastolic volume were associated with decreased LV radial strain (P =.09). There was no association between LV longitudinal, radial, or circumferential dyssynchrony and indexed pulmonary regurgitation flow volume, RV end-diastolic volume, or RV ejection fraction. Conclusions: LV circumferential and radial strain are significantly reduced in children and adolescents after TOF repair and are associated with pulmonary regurgitation and RV dilatation. Resting LV mechanical dyssynchrony does not appear to contribute to early impaired LV strain in this population.
KW - Congenital heart disease
KW - Echocardiography
KW - Left ventricle
KW - Strain imaging
KW - Tetralogy of Fallot
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U2 - 10.1016/j.echo.2012.01.014
DO - 10.1016/j.echo.2012.01.014
M3 - Article
C2 - 22326134
AN - SCOPUS:84860255146
VL - 25
SP - 494
EP - 503
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
SN - 0894-7317
IS - 5
ER -