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. 2017 Dec 11;12(12):e0189128.
doi: 10.1371/journal.pone.0189128. eCollection 2017.

Occult RV systolic dysfunction detected by CMR derived RV circumferential strain in patients with pectus excavatum

Vien T Truong  1   2 , Candice Y Li  3 , Rebeccah L Brown  4 , Ryan A Moore  3 , Victor F Garcia  4 , Eric J Crotty  5 , Michael D Taylor  3 , Tam M N Ngo  2 , Wojciech Mazur  1
Affiliations

Occult RV systolic dysfunction detected by CMR derived RV circumferential strain in patients with pectus excavatum

Vien T Truong et al. PLoS One. .

Abstract

Aims: To investigate the right ventricular (RV) strain in pectus excavatum (PE) patients using cardiac magnetic resonance tissue tracking (CMR TT).

Materials and methods: Fifty consecutive pectus excavatum patients, 10 to 32 years of age (mean age 15 ± 4 years), underwent routine cardiac magnetic resonance imaging (CMR) including standard measures of chest geometry and cardiac size and function. The control group consisted of 20 healthy patients with a mean age of 17 ± 5 years. RV longitudinal and circumferential strain magnitude was assessed by a dedicated RV tissue tracking software.

Results: Fifty patients with images of sufficient quality were included in the analysis. The mean right and left ventricular ejection fractions were 55 ± 5% and 59 ± 4%. The RV global longitudinal strain was -21.88 ± 4.63%. The RV circumferential strain at base, mid-cavity and apex were -13.66 ± 3.09%, -11.31 ± 2.79%, -20.73 ± 3.45%, respectively. There was no statistically significant decrease in right ventricular or left ventricular ejection fraction between patients and controls (p > 0.05 for each). There was no significant difference in RV global longitudinal strain between two groups (-21.88 ± 4.63 versus -21.99 ± 3.58; p = 0.93). However, there was significant decrease in mid-cavity circumferential strain magnitude in pectus patients compared with controls (-11.31 ± 2.79 versus -16.19 ± 2.86; p < 0.001). PE patients had a significantly higher basal circumferential strain (-13.66 ± 3.09% versus -9.76 ± 1.79; p < 0.001) as well as apical circumferential strain (-20.73 ± 3.45% versus -12.07 ± 3.38) than control group.

Conclusion: Mid-cavity circumferential strain but not longitudinal strain is reduced in pectus excavatum patients. Basal circumferential strain as well as apical circumferential strain were increased as compensatory mechanism for reduced mid-cavity circumferential strain. Further studies are needed to establish clinical significance of this finding.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Pectus index and CMR tissue tracking.
(A) The Haller Index (HI) is a ratio of the transverse diameter of the chest (line a) to the distance between the posterior aspect of the sternum and the anterior portion of the vertebra (line b): HI = a/b. The correction index (CI) measures the depression of the sternum relative to the anterior chest: CI = [(c-b)/c] x 100. (B) Right ventricular longitudinal strain. (C) and (D) Mid-cavity circumferential strain and peak value was recorded. The yellow colored contours show the tracking of the ventricle.
Fig 2
Fig 2. Relationship between pectus severity index and right ventricular ejection fraction, myocardial strain.
See this image and copyright information in PMC

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