Echocardiography for assessment of regional and global right ventricular systolic function in adults with repaired tetralogy of Fallot
Section snippets
Study subjects
From our clinic database we identified 101 consecutive adult subjects late after TOF-repair who had both a CMR and an echocardiogram less than 6 months apart (mean time between CMR and echocardiography was 0.7 ± 2.3 months). As a control population for echocardiographic measurements, 50 individuals with structurally normal hearts, referred for exclusion of a PFO were identified. The study was approved by the institutional ethics committee.
Echocardiograms
All transthoracic echocardiograms at our institution are
Study population
The mean age in the control group (50% males) was 38 ± 10 years and the mean age of patients with rTOF (60% males) was 33 ± 12 years (p = 0.05). A comparison of baseline characteristics of patients with rTOF randomly assigned to the derivation and the validation group is given in Table 1. There were no significant differences in any of the baseline characteristics between the two groups.
Acoustic window quality on echocardiography was judged good in 6%, fair in 86% and poor in 8%. No studies were
Discussion
In this study of patients late after TOF repair, echocardiography demonstrated significant differences in the regional systolic RV function as compared to individuals with structurally normal hearts. Patients with rTOF have significantly impaired systolic function of the RVOT. In contrast to rTOF-patients with abnormal CMR-RVEF, patients with rTOF and preserved global systolic RV-function compensate for this loss of RVOT function by the increased contraction of the RV-body.
Longitudinal
Limitations
Although all echocardiographic images at our institution are obtained according to a defined protocol, analysis of images was retrospective. For individuals in the control group with structurally normal hearts we assumed normal RV systolic function but CMR-data was not available. On the other hand, the regional systolic RV function was not available on CMR. Echocardiographic measurements of TAPSE were not made on M-mode images as originally proposed [30]. In patients with severely dilated RVs,
Conclusions
Patients with repaired tetralogy of Fallot have a markedly different pattern of regional systolic right ventricular function compared to individuals with structurally normal hearts. Radial contraction of the RVOT is impaired in most patients but those with preserved global systolic right ventricular function can compensate this loss of function with increased contractions of the body of the right ventricle. A quantitative echocardiographic model incorporating measures of systolic function of
Acknowledgement
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [31].
Conflicts of interest: None.
Relationship to industry: None.
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