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. 2023 Sep;39(9):1631-1641.
doi: 10.1007/s10554-023-02857-3. Epub 2023 Jul 5.

Comprehensive echocardiographic assessment of right ventricular function, pulmonary arterial elastic properties and ventricular-vascular coupling in adult patients with repaired tetralogy of fallot: clinical significance of 3D derived indices

Antonio Vitarelli  1   2 , Fabio Miraldi  3 , Lidia Capotosto  3   4 , Nicola Galea  3 , Marco Francone  3 , Livia Marchitelli  3 , Nicola Viceconte  3 , Costantino Smaldone  5 , Enrico Mangieri  3 , Bich Lien Nguyen  3 , Gaetano Tanzilli  3 , Massimo Mancone  3 , Sulaiman Al-Kindy  3
Affiliations

Comprehensive echocardiographic assessment of right ventricular function, pulmonary arterial elastic properties and ventricular-vascular coupling in adult patients with repaired tetralogy of fallot: clinical significance of 3D derived indices

Antonio Vitarelli et al. Int J Cardiovasc Imaging. 2023 Sep.

Abstract

We aimed to comprehensively analyze by three-dimensional speckle-tracking echocardiography (3DSTE) and Doppler echocardiography right ventricular (RV) performance, pulmonary arterial (PA) elastic properties and right ventricular-pulmonary artery coupling (RVPAC) in patients with repaired tetralogy of Fallot (rTOF) and assess the feasibility and clinical utility of related echocardiographic indices. Twenty-four adult patients with rTOF and twenty-four controls were studied. RV end-diastolic volume(3D-RVEDV), RV end-systolic volume(3D-RVESV), RV ejection fraction(3D-RVEF), RV longitudinal strain(3D-RVLS) and RV area strain(3D-RVAS) were calculated by 3DSTE. RV end-systolic area (RVESA) was obtained by planimetry. Pulmonary regurgitation (PR) was assessed as trivial/mild or significant by cardiac magnetic resonance (CMR) and color-Doppler. Pulmonary artery (PA) elastic properties were determined using two-dimensional/Doppler echocardiography. RV systolic pressure (RVSP) was measured using standard Doppler methods. RVPAC was assessed using various 3DSTE-derived parameters (3DRVAS/RVSP, 3DRVLS/RVESA, 3DRVAS/RVESV). Overall, 3DRVEF and 3DRVAS were impaired in rTOF patients compared with controls. PA pulsatility and capacitance were reduced (p = 0.003) and PA elastance was higher (p = 0.0007) compared to controls. PA elastance had a positive correlation with 3DRVEDV (r = 0.64, p = 0.002) and 3DRVAS (r = 0.51, p = 0.02). By ROC (receiver operating characteristics) analysis, 3DRVAS/RVESV, 3DRVAS/RVSP and 3DRVLS/RVESA cutoff values of 0.31%/mmHg, 0.57%/mmHg and 0.86%/mmHg, respectively, had 91%, 88% and 88% sensitivity and 81%, 81% and 79% specificity in identifying exercise capacity impairment. In rTOF patients increased 3DSTE-derived RV volumes and impaired RV ejection fraction and strain are associated with reduced PA pulsatility and capacitance and increased PA elastance. 3DSTE-derived RVPAC parameters using different afterload-markers are accurate indices of exercise capacity.

Keywords: Pulmonary artery elastance; Repaired tetralogy of Fallot; Right ventricular function; Right ventricular-pulmonary artery coupling; Three-dimensional speckle tracking echocardiography.

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References

    1. Mercer-Rosa L, Yang W, Kutty S, Rychik J, Fogel M, Goldmuntz E (2012) 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 5:637–643. https://doi.org/10.1161/CIRCIMAGING.112.972588 - DOI
    1. Lee C, Lee CH, Kwak JG, Kim SH, Shim WS, Lee SY et al (2014) Factors associated with right ventricular dilatation and dysfunction in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot: analysis of magnetic resonance imaging data from 218 patients. J Thorac Cardiovasc Surg 148:2589–2595. https://doi.org/10.1016/j.jtcvs.2014.07.051 - DOI
    1. Nochioka K, Querejeta Roca G, Claggett B, Biering-Sørensen T, Matsushita K, Hung CL et al (2018) Right ventricular function, right ventricular-pulmonary artery coupling, and heart failure risk in 4 US communities: the atherosclerosis risk in communities (ARIC) study. JAMA Cardiol 3:939–948. https://doi.org/10.1001/jamacardio.2018.2454 - DOI
    1. Aubert R, Venner C, Huttin O, Haine D, Filippetti L, Guillaumot A et al (2018) Three-dimensional echocardiography for the assessment of right ventriculo-arterial coupling. J Am Soc Echocardiogr 31(8):905–915. https://doi.org/10.1016/j.echo.2018.04.013 - DOI
    1. Bedard E, McCarthy KP, Dimopoulos K, Giannakoulas G, Gatzoulis MA, Ho SY (2009) Structural abnormalities of the pulmonary trunk in tetralogy of Fallot and potential clinical implications: a morphological study. J Am Coll Cardiol 54:1883–1890. https://doi.org/10.1016/j.jacc.2009.06.040 - DOI

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