In patients with corrected tetralogy of Fallot (cToF), left ventricular (LV) dysfunction is closely related to right ventricular (RV) dysfunction, indicating adverse ventricular–ventricular ...interactions. However, the mechanism that links RV dysfunction to LV dysfunction remains unclear. In this prospective study, 32 patients with cToF and 19 controls were enrolled. With cardiac magnetic resonance imaging, biventricular ejection fractions were assessed. Using 2-dimensional speckle tracking, global and regional RV and LV strains and LV twist were assessed. To detect and characterize ventricular–ventricular interaction, the relation between global and regional RV mechanics and global and regional LV mechanics was assessed. Global RV strain, global LV strain, and LV twist were decreased in patients with cToF. Global RV strain correlated with global LV strain (r = 0.66, p <0.001) and LV twist (r = −0.72, p <0.001), indicating the presence of adverse ventricular–ventricular interaction. Furthermore, close relations were observed between apical RV strain and apical LV strain (r = 0.62, p <0.001) and apical LV rotation (r = −0.67, p <0.001). In conclusion, RV strain was significantly related to LV strain and LV twist in patients with cToF and controls. Furthermore, apical RV strain correlated with apical LV strain and apical LV rotation, indicating adverse apical ventricular–ventricular interactions.
The accurate assessment of right ventricular (RV) function and dimensions has important prognostic implications in patients with repaired tetralogy of Fallot (ToF). Three-dimensional imaging is the ...preferred methodology to evaluate RV function. Novel postprocessing software applications to evaluate three-dimensional data have provided insight into RV function and dimensions by analyzing the various RV components (inlet, apical trabecular, outlet). The aim of this study was to characterize regional RV function and dimensions with real-time three-dimensional echocardiography (RT3DE) in patients with repaired ToF.
Forty-one patients with repaired ToF (age range, 8-18 years) and 20 control subjects were enrolled. Global and segmental RV volumes and ejection fraction (EF) were assessed with RT3DE and compared between patients with repaired ToF and controls.
Segmental analysis on RT3DE demonstrated that the apical trabecular region was the most remodeled RV component in patients with repaired ToF, with significantly increased end-diastolic volume and end-systolic volume compared with controls (59 ± 19 vs 41 ± 16 mL and 36 ± 13 vs 24 ± 8 mL, respectively; P = .001 for both). However, EF was preserved at that region. In contrast, EF was reduced at the RV inlet (53 ± 6% vs 58 ± 7%, P = .003) and outlet (44 ± 16% vs 52 ± 10% (P = .032).
Patients with repaired ToF show characteristic RV remodeling as assessed with RT3DE. At the apical trabecular region, the largest volumes were observed compared with control patients, whereas EF at the inlet and outlet components was significantly impaired. RT3DE may facilitate future studies of segmental RV volumes and function in patients with repaired ToF.
Background Previous studies demonstrated that ventricular response to stress cardiovascular magnetic resonance (CMR) is frequently abnormal in patients with a systemic right ventricle (RV). However, ...the clinical implications of these findings remained unknown. We sought to evaluate whether abnormal response to stress CMR predicts adverse outcome in patients with a systemic RV. Methods Thirty-nine adult patients (54% male; mean age 26, range 18-65 years) with a systemic RV underwent stress CMR to determine the response of RV volumes and ejection fraction (EF). During follow-up, cardiac events, defined as hospitalization for heart failure, cardiac surgery, aborted cardiac arrest, or death, were recorded. The prognostic value of an abnormal response to stress, defined as lack of a decrease in RV end-systolic volume (ESV) or lack of an increase in RV EF, was assessed. Results We frequently observed an abnormal response to stress, as RV ESV did not decrease in 17 patients (44%), and RV EF did not increase in 15 patients (38%). After a mean follow-up period of 8.1 years, 8 (21%) patients had reached the composite end point. The inability to decrease RV ESV during stress was predictive for cardiac events with a hazard ratio of 2.3 (95% CI 1.19-88.72, P = .034), as was the inability to increase RV EF with a hazard ratio of 2.3 (95% CI 1.31-81.59, P = .027). Conclusions Stress CMR potentially has important prognostic value in patients with a systemic RV. Patients with a systemic RV who show abnormal cardiac response to stress have a substantially higher risk of adverse outcome.
