Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, United Kingdom.
Am Heart J. 2012 May;163(5):859-66. doi: 10.1016/j.ahj.2012.01.038.
Transposition of the great arteries (TGA) after atrial switch operation and congenitally corrected TGA (ccTGA) are commonly associated with impaired systemic right ventricular (RV) function and impaired prognosis. We aimed to investigate the value of indices of myocardial deformation on speckle-tracking echocardiography for quantifying ventricular function and their potential role in assessing ventricular-ventricular interaction and outcome in patients with a systemic RV.
A total of 129 patients (87 with TGA and atrial switch and 42 with ccTGA, 71 men, age 35 ± 12 years) were investigated, and biventricular myocardial deformation was compared with findings in healthy subjects (n = 38, age 36 ± 10 years). Systemic ventricular longitudinal 2-dimensional (2D) peak systolic strain (RV 2D-LS) was significantly reduced compared with controls (-12.9 ± 3.6 and -15.4 ± 5.1 vs -21.0 ± 5.5 in TGAs, ccTGAs, and controls, P < .0001). Systemic and pulmonary 2D-LS were correlated in patients with TGA (r = 0.46, P < .0001) and ccTGA (r = 0.64, P < .0001), suggesting interventricular interaction, and this was confirmed when ejection fraction on magnetic resonance imaging was assessed (r = 0.53, P < .0001). More importantly, systemic 2D-LS (hazard ratio 1.31, P = .01) was related to adverse clinical outcome (symptomatic progression to New York Heart Association class ≥3, clinically relevant cardiac arrhythmia, or death) in patients with TGA and atrial switch independently of ejection fraction on cardiac magnetic resonance imaging, history of clinically relevant arrhythmia, or functional class.
Global longitudinal systolic strain is significantly reduced in patients with a systemic RV, is related to subpulmonary ventricular function, and predicts adverse clinical outcome in adults with atrial switch TGA.
大动脉转位（TGA）经心房调转术后和矫正性大动脉转位（ccTGA）常伴有系统性右心室（RV）功能受损和预后不良。我们旨在研究斑点追踪超声心动图心肌应变指数在量化心室功能中的价值，及其在评估系统性 RV 患者心室-心室相互作用和结局中的潜在作用。
共纳入 129 例患者（87 例 TGA 经心房调转术，42 例 ccTGA，71 例男性，年龄 35±12 岁），并将双心室心肌应变与健康对照者（n=38，年龄 36±10 岁）进行比较。与对照组相比，系统性心室纵向 2 维应变（RV 2D-LS）明显降低（TGA、ccTGA 和对照组分别为-12.9±3.6、-15.4±5.1 和-21.0±5.5，P<0.0001）。TGA 患者（r=0.46，P<0.0001）和 ccTGA 患者（r=0.64，P<0.0001）的系统性和肺 2D-LS 相关，表明存在室间相互作用，当评估心脏磁共振成像射血分数时得到了证实（r=0.53，P<0.0001）。更重要的是，系统性 2D-LS（危险比 1.31，P=0.01）与 TGA 和心房调转术后患者的不良临床结局（纽约心脏协会分级≥3、临床相关心律失常或死亡）相关，独立于心脏磁共振成像射血分数、临床相关心律失常史或功能分级。
系统性 RV 患者的整体纵向收缩应变明显降低，与亚肺心室功能相关，并预测心房调转 TGA 成人的不良临床结局。
