Clinical InvestigationVentricular and Atrial MechanicsRegional Dysfunction of the Right Ventricular Outflow Tract Reduces the Accuracy of Doppler Tissue Imaging Assessment of Global Right Ventricular Systolic Function in Patients with Repaired Tetralogy of Fallot
Section snippets
Patients
Candidates for inclusion in this retrospective study were identified by a search of the computer database of the Department of Cardiology at Children’s Hospital Boston. Consecutive subjects with repaired TOF who fulfilled the following criteria were included: (1) underwent transthoracic echocardiography with RV DTI and CMR within 4 weeks of each other, (2) underwent no transcatheter or cardiac surgical procedure between the echocardiographic and CMR studies, (3) had no history of pulmonary
Results
Echocardiograms and CMR examinations in 51 patients with repaired TOF who met the inclusion criteria were analyzed. Patient demographics, CMR, and DTI data are summarized in Table 1. The echocardiographic and CMR examinations were performed on the same day in 36 patients (71%). The interval between echocardiography and CMR was <1 week in seven patients (13%), between 1 and 2 weeks in three patients (6%), and between 2 and 4 weeks in five patients (10%).
Table 2 summarizes the results of the
Discussion
Patients with repaired TOF require lifelong follow-up that includes serial assessment of RV function. Because the accuracy of quantitative assessment of RV function by two-dimensional echocardiography is hampered by the chamber’s complex geometry,17 nongeometric methods to assess RV myocardial motion and deformation have been explored. One such method, DTI, allows the quantitative assessment of longitudinal RV function on the basis of myocardial velocity estimation at the level of the tricuspid
Conclusions
DTI-derived RV free wall peak S′ and IVA show acceptable correlations with CMR-derived global RV EF in patients with repaired TOF. However, in those with moderate or greater RVOT dysfunction, DTI indices measured at the base of the RV free wall may not accurately reflect global RV systolic function. Peak S′ <8.4 cm/s and IVA <95cm/s2 should prompt further investigation of RV function by CMR. Additional studies are warranted to investigate the utility of DTI and speckle tracking–based indices of
Acknowledgment
We thank David Annese, RT(R), for his assistance with this project.
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2018, American Journal of CardiologyCitation Excerpt :The start date was chosen because routine storage of digital Echos began on that date; (2) available CMR and Echo studies within 1 year of each other; (3) no catheter or surgical intervention between Echo and CMR; and (4) transthoracic Echos with clearly defined spectral waves suitable for MPA Doppler analysis. All studies were performed as part of routine clinical care following a standardized protocol.3,23 Demographic information, including age, sex, and dates of studies, was obtained by reviewing medical records.
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Right ventricular outflow tract function in chronic heart failure
2016, Indian Heart JournalCitation Excerpt :Since the onset of the RV ejection at RVOT occurs 25–50 ms after the contraction of the inflow tract, these result in overall peristalsis-like ventricular motion.2,14–16 The RVOT function has been found to correlate closely with other anatomical, long axis as well as functional parameters and transtricuspid retrograde pressure gradient.11–13 Although the inlet part of the RV has a greater contribution to overall RV function compared with the infundibulum,17–19 some studies have reported a possibility of using RVOT movement or contraction as a marker of RV systolic function.11–13,20