Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Department of Radiology, Queen Mary Hospital, Hong Kong, China.
J Am Soc Echocardiogr. 2014 Apr;27(4):423-9. doi: 10.1016/j.echo.2013.12.021. Epub 2014 Feb 6.
The clinical relevance of evaluating right ventricular (RV) myocardial deformation in congenital heart disease is increasingly recognized. The aim of this study was to explore, using three-dimensional (3D) speckle-tracking echocardiography, RV mechanics in terms of 3D global area strain and mechanical dyssynchrony in adults with repaired tetralogy of Fallot.
Twenty patients (12 men) aged 24.7 ± 8.6 years and 22 age-matched controls (11 men) were studied. Global RV peak area strain and area strain-derived systolic dyssynchrony index (SDI) were determined using 3D speckle-tracking echocardiography. RV end-diastolic volume and end-systolic volume, ejection fraction (EF), and pulmonary regurgitation fraction were measured in patients using cardiac magnetic resonance.
Coefficients of variation for intraobserver and interobserver measurements of RV global area strain were 6.1% and 7.9%, respectively, and those for SDI were 7.6% and 10.1%, respectively. Compared with controls, patients had significantly lower global area strain (P = .005) and greater SDI (P = .008). The prevalence of RV mechanical dyssynchrony (SDI > control mean + 2 SDs) in patients was 30%. In patients, global area strain correlated inversely with SDI (r = -0.42, P = .04), RV end-diastolic volume (r = -0.48, P = .032), and RV end-systolic volume (r = -0.48, P = .031) and positively with EF (r = -0.51, P = .02), while RV SDI correlated positively with RV end-systolic volume (r = 0.55, P = .012), pulmonary regurgitation fraction (r = 0.54, P = .031), and QRS duration (r = 0.51, P = .022) and negatively with RV EF (r = -0.62, P = .004). Multivariate analysis showed that RV EF (β = 0.22, P = .048) was a significant correlate of global area strain in patients.
In adults after tetralogy of Fallot repair, 3D RV deformation is impaired in association with RV dyssynchrony, volume overloading, and reduced EF.
评估先天性心脏病右心室（RV）心肌变形的临床相关性正日益受到重视。本研究旨在通过三维（3D）斑点追踪超声心动图，探讨法洛四联症修复后成人 RV 机械运动的整体面积应变和机械不同步。
研究纳入 20 名（男 12 名）年龄 24.7±8.6 岁的患者和 22 名年龄匹配的对照者（男 11 名）。使用 3D 斑点追踪超声心动图确定整体 RV 峰值面积应变和面积应变衍生的收缩不同步指数（SDI）。采用心脏磁共振测量患者的 RV 舒张末期容积、收缩末期容积、射血分数（EF）和肺反流分数。
RV 整体面积应变的观察者内和观察者间变异系数分别为 6.1%和 7.9%，SDI 的变异系数分别为 7.6%和 10.1%。与对照组相比，患者的整体面积应变明显较低（P=0.005），SDI 较大（P=0.008）。患者 RV 机械不同步（SDI＞对照组平均值+2 个标准差）的发生率为 30%。在患者中，整体面积应变与 SDI（r=-0.42，P=0.04）、RV 舒张末期容积（r=-0.48，P=0.032）和 RV 收缩末期容积（r=-0.48，P=0.031）呈负相关，与 EF（r=-0.51，P=0.02）呈正相关，而 RV SDI 与 RV 收缩末期容积（r=0.55，P=0.012）、肺反流分数（r=0.54，P=0.031）和 QRS 持续时间（r=0.51，P=0.022）呈正相关，与 RV EF（r=-0.62，P=0.004）呈负相关。多变量分析显示，RV EF（β=0.22，P=0.048）是患者整体面积应变的显著相关因素。
在法洛四联症修复后的成年人中，3D RV 变形受损与 RV 不同步、容量超负荷和 EF 降低有关。
