Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
Am J Cardiol. 2013 Jun 1;111(11):1644-9. doi: 10.1016/j.amjcard.2013.01.336. Epub 2013 Mar 13.
After repair of tetralogy of Fallot, the left ventricular ejection fraction and the right ventricular ejection fraction are associated with clinical status and outcomes, but the relation of strain, a potentially earlier marker of dysfunction, to quality of life has not been evaluated. In 58 patients with tetralogy of Fallot (median age 29 years, interquartile range 20 to 41) who underwent cardiovascular magnetic resonance imaging and completed the Short Form 36, Version 2 (a validated quality-of-life assessment), left ventricular global circumferential strain, left ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVLSFW) were measured from cine images using feature-tracking software. Age-adjusted z score ≤-1 for the physical component summary or subscales of physical functioning, role-physical, and general health was considered a clinically significant decrease in quality of life. Patients with RVLSFW less than the median had increased odds of decreased physical functioning (odds ratio [OR] 5.4, p = 0.01) and general health (OR 3.5, p = 0.04) subscale scores, which remained significant in patients with right ventricular ejection fractions ≥45% (physical functioning: OR 9.5, p = 0.03; general health: OR 5.9, p = 0.04). Left ventricular global circumferential strain and left ventricular global longitudinal strain did not predict decreased quality of life in this population. Intraobserver and interobserver variability was acceptable for left ventricular global circumferential strain (coefficients of variation 9.5% and 10.0%, respectively) but lower for left ventricular global longitudinal strain (coefficients of variation 17.2% and 16.8%, respectively) and poor for RVLSFW (coefficients of variation 19.9% and 28.8%, respectively). In conclusion, RVLSFW appears to have discriminative ability in this population for decreased quality of life and may yield incremental prognostic value beyond global right ventricular ejection fraction assessment, but further study is needed to evaluate methods to limit variability.
法洛四联症修复后，左心室射血分数和右心室射血分数与临床状态和结局相关，但应变（一种潜在的早期功能障碍标志物）与生活质量的关系尚未得到评估。在 58 例接受心血管磁共振成像并完成简明 36 项健康调查简表（一种经过验证的生活质量评估工具）的法洛四联症患者（中位年龄 29 岁，四分位间距 20 至 41 岁）中，使用特征跟踪软件从电影图像中测量左心室整体周向应变、左心室整体纵向应变和右心室游离壁纵向应变（RVLSFW）。身体成分综合评分或身体功能、角色身体和一般健康亚量表的年龄校正 z 评分≤-1 被认为是生活质量的显著下降。RVLSFW 低于中位数的患者，身体功能（比值比 [OR] 5.4，p=0.01）和一般健康（OR 3.5，p=0.04）亚量表评分下降的可能性更高，在右心室射血分数≥45%的患者中，这仍然具有显著意义（身体功能：OR 9.5，p=0.03；一般健康：OR 5.9，p=0.04）。在该人群中，左心室整体周向应变和左心室整体纵向应变不能预测生活质量下降。左心室整体周向应变的观察者内和观察者间变异性可接受（变异系数分别为 9.5%和 10.0%），但左心室整体纵向应变的变异性较差（变异系数分别为 17.2%和 16.8%），RVLSFW 的变异性较差（变异系数分别为 19.9%和 28.8%）。总之，在该人群中，RVLSFW 似乎对生活质量下降具有判别能力，并且可能在评估全球右心室射血分数之外提供额外的预后价值，但需要进一步研究来评估限制变异性的方法。
