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Steinmetz M, Stümpfig T, Seehase M, Schuster A, Kowallick J, Müller M, Unterberg-Buchwald C, Kutty S, Lotz J, Uecker M, Paul T. Impaired Exercise Tolerance in Repaired Tetralogy of Fallot Is Associated With Impaired Biventricular Contractile Reserve: An Exercise-Stress Real-Time Cardiovascular Magnetic Resonance Study. Circ Cardiovasc Imaging 2021; 14:e011823. [PMID: 34384226 DOI: 10.1161/circimaging.120.011823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Correction of tetralogy of Fallot (cTOF) often results in pulmonary valve pathology and right ventricular (RV) dysfunction. Reduced exercise capacity in cTOF patients cannot be explained by these findings alone. We aimed to explore why cTOF patients exhibit impaired exercise capacity with the aid of a comprehensive cardiopulmonary exercise testing (CPET) and real-time cardiovascular magnetic resonance exercise testing (CMR-ET) protocol. METHODS Thirty three cTOF patients and 35 matched healthy controls underwent CPET and CMR-ET in a prospective case-control study. Real-time steady-state free precession cine and phase-contrast sequences were obtained during incremental supine in-scanner cycling at 50, 70, and 90 W. RV and left ventricle (LV) volumes and pulmonary blood flow (Qp) were calculated. Differences of CPET and CMR-ET between cTOF versus controls and correlations between CPET and CMR-ET parameters in cTOF were evaluated statistically for all CMR exercise levels using Mann-Whitney U and Spearman rank-order correlation tests. RESULTS CPET capacity was significantly lower in cTOF than in controls. cTOF patients exhibited not only significantly reduced Qp and RV function but also lower LV function on CMR-ET. Higher CPET values in cTOF correlated with higher Qp (Qp 90 W versus carbon dioxide ventilatory equivalent %: R=-0.519, P<0.05), higher LV-end-diastolic volume indexed to body surface area (LV-end-diastolic volume indexed to body surface area at 50 W versus oxygen uptake in % at maximum exercise on CPET R=0.452, P<0.05), and change in LV ejection fraction (EF; LV-EF at 90 W versus Watt %: r=-0.463, P<0.05). No correlation was found with regard to RV-EF. Significant RV-LV interaction was observed during CMR-ET (RV-EF versus LV-EF at 50 W and 70 W: r=0.66, P<0.02 and r=0.52, P<0.05, respectively). CONCLUSIONS Impaired exercise capacity in cTOF resulted from a reduction in not only RV, but also LV function. cTOF with good exercise capacity on CPET demonstrated higher LV reserve and pulmonary blood flow during incremental CMR-ET. Apart from RV parameters, CMR-ET-derived LV function could be a valuable tool to stratify cTOF patients for pulmonary valve replacement.
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Affiliation(s)
- Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Thomas Stümpfig
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Matthias Seehase
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.)
| | - Andreas Schuster
- Department of Cardiology and Pneumology (A.S., C.U.-B.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Johannes Kowallick
- Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Matthias Müller
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.)
| | - Christina Unterberg-Buchwald
- Department of Cardiology and Pneumology (A.S., C.U.-B.).,Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Shelby Kutty
- University Medical Center, Georg-August-University, Goettingen, Germany. The Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Martin Uecker
- Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.).,Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Goettingen, Germany (M.U.)
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
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López-Candales A, Vallurupalli S. Strain generation and right ventricular systolic function: The sum of all its parts. Echocardiography 2021; 38:871-877. [PMID: 33950528 DOI: 10.1111/echo.15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/01/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Speckle-tracking echocardiography (STE) has provided a reliable means to enhance characterization and quantification of global right ventricular (RV) systolic function. The use of Automated Functional Imaging (AFI) software has been previously used to quantify RV longitudinal peak global strain (PGS) values during two-dimensional (2D) transthoracic echocardiographic examinations. However, there is a paucity of data regarding relative strain contribution of each individual regional segments when compared with global strain assessment. Consequently, our goal was to use AFI STE to examine the strain contribution of each regional segment when assessing RV function. METHODS A retrospective analysis was performed on 107 patients that met our study criteria to correlate 2D TTE measures of RV systolic function to both RV AFI STE longitudinal peak global strain (PGS) and each individual regional RV free wall (RVFw) and inter-ventricular septum (IS) strain values. RESULTS We found that TTE variables of RV systolic function only correlated with PGS (RVFAC; P < .0001, TAPSE; P < .0001, and TA TDI S'; P < .0001) but none of the six individual regional AFI strain values. When PGS was not included in the multivariate analysis, only the mid RVFw and mid IS strain regions correlated with measures of RV systolic function. CONCLUSIONS Regional differences do exist with regards to strain generation along the RVFw and IS. These differences could be physiologically and anatomically explained based on our current understanding of RV muscle fiber arrangement. Further research is now needed to better characterize RV function in different clinical entities.
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Affiliation(s)
- Angel López-Candales
- Cardiovascular Medicine Division, Truman Medical Center, University of Missouri, Kansas City, MO, USA
| | - Srikanth Vallurupalli
- The Cardiology Department, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Olive MK, Fraser CD, Kutty S, McKenzie ED, Hammel JM, Krishnamurthy R, Dodd NA, Maskatia SA. Infundibular sparing versus transinfundibular approach to the repair of tetralogy of Fallot. CONGENIT HEART DIS 2020; 14:1149-1156. [DOI: 10.1111/chd.12863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/10/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Mary K. Olive
- Department of Pediatrics, Section of Pediatric Cardiology Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Ann Arbor Michigan
| | - Charles D. Fraser
- Department of Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease University of Texas Dell Medical School, Dell Children’s Medical Center Austin Texas
| | - Shelby Kutty
- Department of Pediatrics Taussig Congenital Heart Center, Johns Hopkins University Baltimore Maryland
| | - Emmett D. McKenzie
- Section of Congenital Heart Surgery Texas Children’s Hospital, Baylor College of Medicine Houston Texas
| | - James M. Hammel
- Section of Cardiovascular Surgery University of Nebraska College of Medicine Omaha Nebraska
| | - Rajesh Krishnamurthy
- Section of Diagnostic Radiology Nationwide Children’s Hospital, Ohio State University Columbus Ohio
| | - Nicolas A. Dodd
- Section of Pediatric Radiology Texas Children’s Hospital, Baylor College of Medicine Houston Texas
| | - Shiraz A. Maskatia
- Section of Pediatric Cardiology Stanford University Palo Alto California
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Moceri P, Duchateau N, Baudouy D, Schouver ED, Leroy S, Squara F, Ferrari E, Sermesant M. Three-dimensional right-ventricular regional deformation and survival in pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2019. [PMID: 28637308 DOI: 10.1093/ehjci/jex163] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims Survival in pulmonary hypertension (PH) relates to right ventricular (RV) function. However, the RV unique anatomy and structure limit 2D analysis and its regional 3D function has not been studied yet. The aim of this study was to assess the implications of global and regional 3D RV deformation on clinical condition and survival in adults with PH and healthy controls. Methods and results We collected a prospective longitudinal cohort of 104 consecutive PH patients and 34 healthy controls between September 2014 and December 2015. Acquired 3D transthoracic RV echocardiographic sequences were analysed by semi-automatic software (TomTec 4D RV-Function 2.0). Output meshes were post-processed to extract regional motion and deformation. Global and regional statistics provided deformation patterns for each subgroup of subjects. RV lateral and inferior regions showed the highest deformation. In PH patients, RV global and regional motion and deformation [both circumferential, longitudinal, and area strain (AS)] were affected in all segments (P < 0.001 against healthy controls). Deformation patterns gradually worsened with the clinical condition. Over 6.7 [5.8-7.2] months follow-up, 16 (15.4%) patients died from cardio-pulmonary causes. Right atrial pressure, global RV AS, tricuspid annular plane systolic excursion, 3D RV ejection fraction, and end-diastolic volume were independent predictors of survival. Global RV AS > -18% was the most powerful RV function parameter, identifying patients with a 48%-increased risk of death (AUC 0.83 [0.74-0.90], P < 0.001). Conclusion Right ventricular strain patterns gradually worsen in PH patients and provide independent prognostic information in this population.
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Affiliation(s)
- Pamela Moceri
- Université Côte d'Azur, Inria Asclepios Research Project, 2004 route des Lucioles - BP 93, 06902 Sophia Antipolis, France.,Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France.,Faculté de médecine, Université Côte d'Azur, 28 avenue Valombrose 06107 NICE, France
| | - Nicolas Duchateau
- Université Côte d'Azur, Inria Asclepios Research Project, 2004 route des Lucioles - BP 93, 06902 Sophia Antipolis, France
| | - Delphine Baudouy
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France
| | - Elie-Dan Schouver
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France.,Faculté de médecine, Université Côte d'Azur, 28 avenue Valombrose 06107 NICE, France
| | - Sylvie Leroy
- Department of Pneumology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France
| | - Fabien Squara
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France
| | - Emile Ferrari
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France.,Faculté de médecine, Université Côte d'Azur, 28 avenue Valombrose 06107 NICE, France
| | - Maxime Sermesant
- Université Côte d'Azur, Inria Asclepios Research Project, 2004 route des Lucioles - BP 93, 06902 Sophia Antipolis, France
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Dłużniewska N, Podolec P, Skubera M, Smaś-Suska M, Pająk J, Urbańczyk-Zawadzka M, Płazak W, Olszowska M, Tomkiewicz-Pająk L. Long-term follow-up in adults after tetralogy of Fallot repair. Cardiovasc Ultrasound 2018; 16:28. [PMID: 30373624 PMCID: PMC6206664 DOI: 10.1186/s12947-018-0146-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease and the population of ToF repair survivors is growing rapidly. Adults with repaired ToF develop late complications. The aim of this study was to describe and analyze long-term follow-up of patients with repaired ToF. Methods This is a retrospective cohort study. Consecutive 83 patients with repaired ToF who did not undergo pulmonary valve replacement were included. Mean age of all patients was 30.5 ± 10.7. There were 49 (59%) male. Patients were divided into two groups according to the time since the repair (< 25 years and ≥ 25 years). The electrocardiographic (ECG), cardiopulmonary exercise testing (CPET), echocardiographic and cardiac magnetic resonance (CMR) data were reviewed retrospectively. Results In CPET values were not significantly different in the two groups. In CMR volumes of left and right ventricles were not significantly different in the two groups. There were no differences between the groups in ventricular ejection fraction, mass of ventricles, or pulmonary regurgitation fraction. Among all the patients, ejection fraction and left and right ventricle mass, indexed pulmonary regurgitation volume measured by CMR did not correlate with the time since repair. In ECG among all the patients, ejection fraction of the RV, measured in CMR, negatively correlated with QRS duration (r = − 0.43; p < 0.001). There was a positive correlation between QRS duration and end diastolic volume of the RV (r = 0.30; p < 0.02), indexed end diastolic volume of the RV (r = 0.29; p = 0.04), RV mass (r = 0.36; p < 0.001) and left ventricle mass (r = 0.26; p = 0.04). Conclusion Long-term survival and clinical condition after surgical correction of ToF in infancy is generally good and the late functional status in ToF – operated patients could be excellent up to 25 years after the repair. QRS duration could be an utility and easy factor to assessment of right ventricular function. Trial registration The study protocol was approved by the local Ethics Committee. Each participant provided informed consent to participate in the study (license number 122.6120.88.2016 from 28.04.2016).
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Affiliation(s)
- Natalia Dłużniewska
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Maciej Skubera
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Monika Smaś-Suska
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Jacek Pająk
- Paediatric Heart Surgery Department and General Paediatric Surgery Department, Medical University of Warsaw, Warsaw, Poland
| | | | - Wojciech Płazak
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Maria Olszowska
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Lidia Tomkiewicz-Pająk
- Department of Cardiac and Vascular Disease, Collegium Medicum, Jagiellonian University, John Paul II Hospital, Krakow, Poland.
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DiLorenzo MP, Elci OU, Wang Y, Banerjee A, Sato T, Ky B, Goldmuntz E, Mercer-Rosa L. Longitudinal Changes in Right Ventricular Function in Tetralogy of Fallot in the Initial Years after Surgical Repair. J Am Soc Echocardiogr 2018; 31:816-821. [PMID: 29627138 PMCID: PMC6035101 DOI: 10.1016/j.echo.2018.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Right ventricular (RV) dysfunction is associated with adverse long-term outcomes in patients with tetralogy of Fallot. Little is known about RV function in the first years after surgical repair. The aim of this study was to investigate perioperative changes in myocardial deformation using global longitudinal strain. METHODS A retrospective analysis of patients with surgically repaired tetralogy of Fallot was performed. Global longitudinal peak systolic RV strain was measured on early postoperative echocardiograms, two subsequent postoperative echocardiograms through 2 years postoperatively, and preoperative echocardiograms, when available. Preoperative and late follow-up strain was compared with strain in 0- to 8-month-old and 1- to 4-year-old control subjects, respectively. RESULTS Forty-seven patients were included. Compared with postoperative strain (7 ± 7 days postoperatively), strain at follow-up 1 (8.3 ± 4 months postoperatively) was significantly improved (-12.3 ± 3.3% vs -18.8 ± 2.5%, P < .001), with no additional improvement 23.2 ± 6 months postoperatively (-18.8 ± 2.5% vs -19.8 ± 3.1%, P = .12). Postoperative strain was worse than preoperative strain (n = 25, -12.5 ± 3.6% vs -18.4 ± 2.9%, P < .001). Compared with control subjects, preoperative strain was similar (-19.3 ± 3.8% vs -18.4 ± 2.9%, P = .30), though late follow-up strain was significantly worse (-27.7 ± 2.8% vs -19.8 ± 3.1%, P < .001). CONCLUSIONS RV global longitudinal strain worsens in the early postoperative period following surgical repair of tetralogy of Fallot but recovers through 2 postoperative years. Despite recovery to preoperative values, the presence of RV dysfunction compared with control subjects suggests that long-term dysfunction may begin early. The trajectory of RV dysfunction through the later years needs further study.
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Affiliation(s)
- Michael P DiLorenzo
- Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
| | - Okan U Elci
- Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yan Wang
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anirban Banerjee
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tomoyuki Sato
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Penn Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Goldmuntz
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura Mercer-Rosa
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Systolic Function of Right Ventricular Outflow Tract is a Better Predictor to Exercise Performance After Pulmonary Valve Replacement in Tetralogy of Fallot. Pediatr Cardiol 2017; 38:1556-1561. [PMID: 28741094 DOI: 10.1007/s00246-017-1695-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
Abstract
Debate on the proper timing of pulmonary valve replacement (PVR) after repair of tetralogy of Fallot is still continuing. We aim to clarify how the different components of right ventricle (RV) changed with relieved volume overload in the remodeling process after pulmonary valve replacement and gain a clear idea of the relationship between different right ventricle components function and exercise capacity after PVR in these patients. The medical records and results of cardiac magnetic resonance imaging and cardiopulmonary exercise testing of 25 consecutive eligible patients were reviewed. End-diastolic, end-systolic, and ejection fraction (EF) were determined for the total RV and its components before and after PVR. There was a marked increase in EF for the outlet after PVR (39.5 ± 11.4 vs. 45.6 ± 12.7, P = 0.04); however, EF and volume change for the other components showed no significant difference. Peak oxygen consumption (VO2) correlated better with the RV outflow tract EF than with the EF of other components of the RV or the global EF (r = 0.382, P = 0.018), and the time interval between initial repair and PVR showed a significant correlation with peak VO2 (r = -0.339, P = 0.037). Multivariate analysis showed the RV outflow tract EF to be the only independent predictor of exercise capacity (β = 0.479; P = 0.046). The systolic function of the RV outflow tract could be a reliable determinant of intrinsic RV performance in repaired TOF (rTOF) patients and a promising parameter for deciding timing of pulmonary valve replacement so as to achieve the best possible exercise capacity in repaired TOF patients.
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Omelchenko AY, Soynov IA, Gorbatykh YN, Kulyabin YY, Gorbatykh AV, Nichay NR, Voitov AV, Bogochev-Prokophiev AV. [Right ventricular dysfunction after tetralogy of Fallot repair: are all questions resolved?]. Khirurgiia (Mosk) 2017. [PMID: 28638021 DOI: 10.17116/hirurgia2017684-90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Yu Omelchenko
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - I A Soynov
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Yu N Gorbatykh
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Yu Yu Kulyabin
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - A V Gorbatykh
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - N R Nichay
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - A V Voitov
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - A V Bogochev-Prokophiev
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
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Luo S, Li J, Yang D, Zhou Y, An Q, Chen Y. Right ventricular outflow tract systolic function correlates with exercise capacity in patients with severe right ventricle dilatation after repair of tetralogy of Fallot. Interact Cardiovasc Thorac Surg 2017; 24:755-761. [DOI: 10.1093/icvts/ivw424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/29/2016] [Indexed: 11/14/2022] Open
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NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study. Neth Heart J 2016; 24:653-665. [PMID: 27620913 PMCID: PMC5065538 DOI: 10.1007/s12471-016-0896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives N-terminal B‑type natriuretic peptide (NT-proBNP) is an important biomarker for the detection of heart failure. Adults with congenital heart disease (ACHD) and a prosthetic heart valve are at risk for heart failure. This study aimed to determine the value of NT-proBNP in ACHD patients with a prosthetic valve and investigate its relationship with cardiac function and exercise capacity. Methods In this multi-centre cross-sectional observational study, data regarding medical history, echocardiography, exercise testing (VO2peak) and laboratory blood evaluation (including NT-proBNP) were collected in ACHD patients with a single prosthetic valve (either homografts, heterografts or mechanical valves). Results A total of 306 ACHD patients with pulmonary valve replacement (PVR, n = 139), aortic valve replacement (n = 141), mitral valve replacement (n = 21) or tricuspid valve replacement (n = 5) were investigated. The majority of patients (77 %) were in NYHA class I or II. Elevated NT-proBNP levels (cut-off ≥125 pg/ml) were found in 50 % of the patients, with the highest levels in patients with mitral valve replacements. In this study population, NT-proBNP levels were associated with gender (p = 0.029) and VO2max (p < 0.001). In PVR patients, NT-proBNP levels were associated with lower VO2peak, also after adjustment for age, gender and age at valve replacement in a multivariate model (p = 0.015). Conclusions In patients with ACHD and a prosthetic valve, elevated NT-proBNP levels are frequently observed despite preserved NYHA class. In PVR patients, a higher NT-proBNP level was associated with a lower VO2peak. These results may be of importance in the ongoing discussion about the timing of valve replacement in patients with CHD.
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Yao Q, Hu XH, Shen QL, Qiao ZW, Pa ME, Qian B, Yan WL, Huang GY. Differential Effect of the Ratio of Right Ventricular Volume to Left Ventricular Volume in Children with Repaired Tetralogy of Fallot. Cardiology 2015; 133:135-40. [DOI: 10.1159/000441291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/23/2015] [Indexed: 11/19/2022]
Abstract
We aimed to compare the diagnostic value of indexed right ventricular end-diastolic volume (RVEDVi) and the ratio of right ventricle volume to left ventricle volume (RV/LV ratio) in prediction of the severity of pulmonary regurgitation (PR) expressed as the PR fraction (PRF) after surgery of tetralogy of Fallot (TOF). Forty-one patients with repaired TOF were included in the study. RVEDVi, LVEDVi, RV/LV ratio, PRF and ejection fraction were measured with magnetic resonance imaging. A PRF of more than 20% was considered significant. The predictive capability of two markers (RVEDVi and RV/LV ratio) for significant PR was compared using multivariate linear regression analysis and receiver operating characteristic (ROC) analysis. Both the RV/LV ratio and RVEDVi showed a correlation with PRF (r = 0.526/0.321, p = 0.001/0.041) in the correlation analysis, but in multivariate regression analysis the only independent predictor of PRF was the RV/LV ratio (F = 14.890, p = 0.001). ROC analysis revealed that a better discrimination of significant PR (>20%) from slight types (=20%) PR can be reached with the RV/LV ratio than RVEDVi (AUC = 0.805/0.709, p = 0.01). The RV/LV ratio was better than RVEDVi at differentiating mild from moderate PR (p = 0.006 vs. p = 0.153), and proved superior over RVEDVi in predicting PR based on the PRF criterion.
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Abstract
Background The significance of right ventricular ejection fraction (RVEF), independent of left ventricular ejection fraction (LVEF), following isolated coronary artery bypass grafting (CABG) and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR), independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery. Methods From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female) were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered <35% and <45%, respectively. Elective primary procedures include CABG (56%) and valve (44%). Thirty-day outcomes were perioperative complications, length of stay, cardiac re-hospitalizations and early mortaility; long-term (> 30 days) outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months. Findings Forty-eight patients had reduced RVEF (mean 25%) and 61 patients had normal RVEF (mean 50%) (p<0.001). Fifty-four patients had reduced LVEF (mean 30%) and 55 patients had normal LVEF (mean 59%) (p<0.001). Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05). Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03). Reduced LVEF did not influence long-term cardiac re-hospitalization. Conclusion Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures.
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Ye DH, Desjardins B, Hamm J, Litt H, Pohl KM. Regional manifold learning for disease classification. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1236-1247. [PMID: 24893254 PMCID: PMC5450500 DOI: 10.1109/tmi.2014.2305751] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
While manifold learning from images itself has become widely used in medical image analysis, the accuracy of existing implementations suffers from viewing each image as a single data point. To address this issue, we parcellate images into regions and then separately learn the manifold for each region. We use the regional manifolds as low-dimensional descriptors of high-dimensional morphological image features, which are then fed into a classifier to identify regions affected by disease. We produce a single ensemble decision for each scan by the weighted combination of these regional classification results. Each weight is determined by the regional accuracy of detecting the disease. When applied to cardiac magnetic resonance imaging of 50 normal controls and 50 patients with reconstructive surgery of Tetralogy of Fallot, our method achieves significantly better classification accuracy than approaches learning a single manifold across the entire image domain.
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Affiliation(s)
| | - Benoit Desjardins
- Department of Radiology, University of Pennsylvania, Philadelphia,
PA 19104 USA
| | - Jihun Hamm
- Department of Computer Science and Engineering, Ohio State
University, Columbus, OH 43210 USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia,
PA 19104 USA
| | - Kilian M. Pohl
- Center for Health Sciences, SRI International, Menlo Park, CA 94025
USA, and also with the Department of Psychiatry and Behavioral Sciences,
Stanford University, Stanford, CA 94304 USA
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