Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Invest Radiol. 2012 Mar;47(3):189-96. doi: 10.1097/RLI.0b013e31823cbd48.
In patients with corrected Tetralogy of Fallot (cToF), pulmonary regurgitation and subsequent increased right ventricular (RV) end-diastolic volume are diastolic parameters related to adverse outcome. In addition, abnormalities of the RV outflow tract (RVOT) independently promote RV dilatation in cToF patients. Tissue Doppler imaging (TDI) and tissue-velocity magnetic resonance imaging (TV-MRI) enable quantitative assessment of regional diastolic performance by measuring myocardial velocities. Assessment of regional diastolic velocities of the RV may provide insight into the relation between RVOT dysfunction and RV dilatation in cToF patients. The aim of the study was to perform a direct comparison of TV-MRI against TDI to assess regional RV diastolic velocities in cToF patients and control subjects. In addition, the relationship between regional RV diastolic velocities and RV dilatation was investigated.
Thirty-four cToF patients (8-18 years) and 19 controls were studied. Early (E') and late (A') peak diastolic velocities and E'/A' ratio were assessed with TDI and TV-MRI at the RV free wall and at the RVOT. RV volumes and pulmonary regurgitation were quantified with planimetric and 3-dimensional flow MRI, respectively.
Good correlation and agreement were observed between TDI and TV-MRI at both regions of the RV (RV free wall: E': r = 0.92, mean bias: 0.5 cm/s, A': r = 0.92, mean bias: 0.4 cm/s; RVOT: E': r = 0.92, mean bias: -0.3 cm/s, A': r = 0.95, mean bias: 0.03 cm/s). With both imaging techniques, regional RV diastolic velocities were significantly reduced in cToF patients. The E'/A' ratio at the RVOT (assessed with both TDI and TV-MRI) was related to RV end-diastolic volume, even after correction for pulmonary regurgitation (TDI: P < 0.01, TV-MRI: P = 0.05).
TDI and TV-MRI can be used interchangeably for the assessment of regional diastolic velocities and performance of the RV in cToF patients and in healthy controls. Regional diastolic velocities at the RVOT are reduced in cToF patients as compared with controls. In addition to pulmonary regurgitation, impaired diastolic performance at the RVOT is independently related to RV dilatation.
在矫正后的法洛四联症（cToF）患者中，肺动脉瓣反流和随后的右心室（RV）舒张末期容积增加是与不良预后相关的舒张期参数。此外，RV 流出道（RVOT）的异常独立促进 cToF 患者的 RV 扩张。组织多普勒成像（TDI）和组织速度磁共振成像（TV-MRI）通过测量心肌速度能够定量评估局部舒张功能。评估 RV 的局部舒张速度可能有助于了解 cToF 患者中 RVOT 功能障碍与 RV 扩张之间的关系。本研究旨在直接比较 TV-MRI 和 TDI，以评估 cToF 患者和对照组的 RV 局部舒张速度。此外，还研究了局部 RV 舒张速度与 RV 扩张之间的关系。
研究了 34 例 cToF 患者（8-18 岁）和 19 例对照者。用 TDI 和 TV-MRI 在 RV 游离壁和 RVOT 评估早期（E'）和晚期（A'）峰值舒张速度和 E'/A'比值。用平面测量和 3 维流量 MRI 分别量化 RV 容积和肺动脉瓣反流。
在 RV 的两个部位（RV 游离壁：E'：r = 0.92，平均偏差：0.5 cm/s，A'：r = 0.92，平均偏差：0.4 cm/s；RVOT：E'：r = 0.92，平均偏差：-0.3 cm/s，A'：r = 0.95，平均偏差：0.03 cm/s），TDI 和 TV-MRI 之间观察到良好的相关性和一致性。用两种成像技术，cToF 患者的 RV 局部舒张速度明显降低。RVOT 的 E'/A'比值（用 TDI 和 TV-MRI 评估）与 RV 舒张末期容积相关，即使在纠正肺动脉瓣反流后（TDI：P < 0.01，TV-MRI：P = 0.05）。
TDI 和 TV-MRI 可互换用于评估 cToF 患者和健康对照者的 RV 局部舒张速度和功能。与对照组相比，cToF 患者的 RVOT 局部舒张速度降低。除了肺动脉瓣反流外，RVOT 的舒张功能障碍也与 RV 扩张独立相关。
