Right Ventricular Strain Is Associated With Increased Length of Stay After Tetralogy of Fallot Repair
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BACKGROUND: Little is known regarding right ventricular (RV) remodeling immediately after Tetralogy of Fallot (TOF) repair. We sought to describe myocardial deformation by cardiac magnetic resonance imaging (CMR) after TOF repair and investigate associations between these parameters and early post-operative outcomes. METHODS: Fifteen infants underwent CMR without sedation as part of a prospective pilot study after undergoing complete TOF repair, prior to hospital discharge. RV deformation (strain) was measured using tissue tracking, in addition to RV ejection fraction (EF), volumes, and pulmonary regurgitant fraction. Pearson correlation coefficients were used to determine associations between both strain and CMR measures/clinical outcomes. RESULTS: Most patients were male (11/15, 73%), with median age at TOF repair 53 days (interquartile range, 13,131). Most patients had pulmonary stenosis (vs. atresia) (11/15, 73%) and 7 (47%) received a transannular patch as part of their repair. RV function was overall preserved with mean RV EF of 62% (standard deviation [SD], 9.8). Peak radial and longitudinal strain were overall diminished (mean ± SD, 33.80 ± 18.30% and −15.50 ± 6.40%, respectively). Longer hospital length of stay after TOF repair was associated with worse RV peak radial ventricular strain (correlation coefficient (r), −0.54; p = 0.04). Greater pulmonary regurgitant fraction was associated with shorter time to peak radial RV strain (r = −0.55, p = 0.03). CONCLUSIONS: In this small study, our findings suggest presence of early decrease in RV strain after TOF repair and its association with hospital stay when changes in EF and RV size are not yet apparent.
Abstract
BACKGROUND: Little is known regarding right ventricular (RV) remodeling immediately after Tetralogy of Fallot (TOF) repair. We sought to describe myocardial deformation by cardiac magnetic resonance imaging (CMR) after TOF repair and investigate associations between these parameters and early post-operative outcomes. METHODS: Fifteen infants underwent CMR without sedation as part of a prospective pilot study after undergoing complete TOF repair, prior to hospital discharge. RV deformation (strain) was measured using tissue tracking, in addition to RV ejection fraction (EF), volumes, and pulmonary regurgitant fraction. Pearson correlation coefficients were used to determine associations between both strain and CMR measures/clinical outcomes. RESULTS: Most patients were male (11/15, 73%), with median age at TOF repair 53 days (interquartile range, 13,131). Most patients had pulmonary stenosis (vs. atresia) (11/15, 73%) and 7 (47%) received a transannular patch as part of their repair. RV function was overall preserved with mean RV EF of 62% (standard deviation [SD], 9.8). Peak radial and longitudinal strain were overall diminished (mean ± SD, 33.80 ± 18.30% and −15.50 ± 6.40%, respectively). Longer hospital length of stay after TOF repair was associated with worse RV peak radial ventricular strain (correlation coefficient (r), −0.54; p = 0.04). Greater pulmonary regurgitant fraction was associated with shorter time to peak radial RV strain (r = −0.55, p = 0.03). CONCLUSIONS: In this small study, our findings suggest presence of early decrease in RV strain after TOF repair and its association with hospital stay when changes in EF and RV size are not yet apparent.
참고문헌 (27)
- Bailliard F, "Tetralogy of Fallot", Orphanet J Rare Dis, 4, pp.2~ (2009)
- Mercer-Rosa L, "22q11. 2 Deletion syndrome is associated with perioperative outcome in tetralogy of Fallot", J Thorac Cardiovasc Surg, 146, pp.868~873 (2013)
- Mercer-Rosa L, "Predictors of length of hospital stay after complete repair for tetralogy of Fallot : a prospective cohort study", J Am Heart Assoc, 7, pp.e1~e13 (2018)
- Annavajjhala V, "Serial assessment of postoperative ventricular mechanics in young children with tetralogy of Fallot : comparison of transannular patch and valve-sparing repair", Congenit Heart Dis, 14, pp.691~699 (2019)
- Quansheng X, "Primary surgical repair of tetralogy of Fallot in symptomatic neonates and premature infants", Chinese J Thorac Cardiovasc Surg, 33, pp.262~266 (2017)
- DiLorenzo MP, "Longitudinal changes in right ventricular function in tetralogy of Fallot in the initial years after surgical repair", J Am Soc Echocardiogr, 31, pp.816~821 (2018)
- Knauth AL, "Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair", Heart, 94, pp.211~216 (2008)
- Orwat S, "Myocardial deformation parameters predict outcome in patients with repaired tetralogy of Fallot", Heart, 102, pp.209~215 (2016)
- Kilner PJ, "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, 31, pp.794~805 (2010)
- Antonov NK, "Feed and wrap MRI technique in infants", Clin Pediatr(Phila), 56, pp.1095~1103 (2017)
- Valente AM, "How to image repaired tetralogy of Fallot", Circ Cardiovasc Imaging, 10, pp.e004270~ (2017)
- Dennis M, "Adults with repaired tetralogy : low mortality but high morbidity up to middle age", Open Heart, 4, pp.e000564~ (2017)
- Geva T, "Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging", J Am Coll Cardiol, 43, pp.1068~1074 (2004)
- DiLorenzo MP, "Early postoperative remodelling following repair of tetralogy of Fallot utilising unsedated cardiac magnetic resonance : a pilot study", Cardiol Young, 28, pp.697~701 (2018)
- Fogel MA, "Comparison and usefulness of cardiac magnetic resonance versus computed tomography in infants six months of age or younger with aortic arch anomalies without deep sedation or anesthesia", Am J Cardiol, 108, pp.120~125 (2011)
- Shariat M, "Utility of feed-and-sleep cardiovascular magnetic resonance in young infants with complex cardiovascular disease", Pediatr Cardiol, 36, pp.809~812 (2015)
- Orwat S, "Myocardial deformation parameters predict outcome in patients with repaired tetralogy of Fallot", Heart, 102, pp.209~215 (2016)
- Taylor RJ, "Myocardial strain measurement with feature-tracking cardiovascular magnetic resonance : normal values", Eur Heart J Cardiovasc Imaging, 16, pp.871~881 (2015)
- Peng J, "Normal values of myocardial deformation assessed by cardiovascular magnetic resonance feature tracking in a healthy Chinese population : a multicenter study", Front Physiol, 9, pp.1181~ (2018)
- Mercer-Rosa L, "Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot : a comparative analysis of echocardiography and magnetic resonance imaging", Circ Cardiovasc Imaging, 5, pp.637~643 (2012)
- Liu T, "Age-and gender-related normal references of right ventricular strain values by tissue tracking cardiac magnetic resonance : results from a Chinese population", Quant Imaging Med Surg, 9, pp.1441~1450 (2019)
- Haeck ML, "Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension", Circ Cardiovasc Imaging, 5, pp.628~636 (2012)
- Scherptong RWC, "Right ventricular peak systolic longitudinal strain is a sensitive marker for right ventricular deterioration in adult patients with tetralogy of Fallot", Int J Cardiovasc Imaging, 25, pp.669~676 (2009)
- Meier GD, "Contractile function in canine right ventricle", Am J Physiol, 239, pp.H794~H804 (1980)
- Pletzer SA, "The relationship between pre-operative left ventricular longitudinal strain and post-operative length of stay in patients undergoing arterial switch operation is age dependent", Pediatr Cardiol, 40, pp.366~373 (2019)
- Hamada-Harimura Y, "Incremental prognostic value of right ventricular strain in patients with acute decompensated heart failure", Circ Cardiovasc Imaging, 11, pp.e007249~ (2018)
- Smith BC, "Three-dimensional speckle tracking of the right ventricle : toward optimal quantification of right ventricular dysfunction in pulmonary hypertension", J Am Coll Cardiol, 64, pp.41~51 (2014)