Maskatia Shiraz A, Morris Shaine A, Spinner Joseph A, Krishnamurthy Rajesh, Altman Carolyn A
Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex, USA.
Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex, USA.
Congenit Heart Dis. 2015 May-Jun;10(3):E113-22. doi: 10.1111/chd.12265. Epub 2015 Apr 27.
Right ventricular (RV) dilation, RV dysfunction, RV outflow tract obstruction, and branch pulmonary artery stenosis are risk factors associated with the need for future surgical or catheter-based intervention commonly assessed by cardiac magnetic resonance in patients with tetralogy of Fallot who have undergone initial repair. The ability of echocardiography to predict the presence of these risk factors is limited.
We aimed to determine the association between echocardiographic parameters of right ventricular diastolic dysfunction and risk factors for intervention as identified on cardiac magnetic resonance imaging (CMR).
We reviewed all echocardiograms and CMRs performed at our institution within 1 year of each other in patients with repaired tetralogy of Fallot. We evaluated patients for the following: RV systolic dysfunction (RV ejection fraction <45%), RV dilation (right ventricular end-diastolic volume ≥ 160 mL/m(2)), and RV obstruction (RV outflow tract gradient ≥ 3 m/s by echocardiogram or branch pulmonary artery stenosis assessed by CMR). We evaluated for associations between the above CMR findings and echocardiographic parameters of diastolic function.
CMR and echocardiographic images performed between March 2007 and March 2012 were available in 99 patients. RV obstruction was associated with lower E/A ratio (P = .02), E/A reversal (P = .02), and prograde end diastolic pulmonary flow (P < .01). Low tricuspid annular a' and low septal s' were associated with lower RV ejection fraction (P < .01, P < .01). Elevated E/e' was associated with higher RV end diastolic volume (P = .04). In predicting the presence of any of the evaluated risk factors for future intervention, TV E/e' ≥ 4.7 had positive predictive value (PPV) of 86% and negative predictive value (NPV) of 50%, TV E/A reversal had PPV of 89% and NPV of 34, and prograde end diastolic pulmonary flow on echocardiogram had PPV of 91% and NPV of 38%.
Echocardiographic parameters of diastolic dysfunction have a reasonable PPV but poor NPV for predicting clinically significant risk factors identified by CMR.
右心室（RV）扩张、右心室功能障碍、右心室流出道梗阻以及分支肺动脉狭窄是法洛四联症患者首次修复术后通常通过心脏磁共振评估的与未来手术或导管介入需求相关的危险因素。超声心动图预测这些危险因素存在的能力有限。
我们旨在确定右心室舒张功能障碍的超声心动图参数与心脏磁共振成像（CMR）所确定的介入危险因素之间的关联。
我们回顾了我院在1年内对法洛四联症修复术后患者进行的所有超声心动图和CMR检查。我们评估患者是否存在以下情况：右心室收缩功能障碍（右心室射血分数<45%）、右心室扩张（右心室舒张末期容积≥160 mL/m²）以及右心室梗阻（超声心动图显示右心室流出道梯度≥3 m/s或CMR评估的分支肺动脉狭窄）。我们评估上述CMR结果与舒张功能的超声心动图参数之间的关联。
2007年3月至2012年3月期间进行的CMR和超声心动图图像可供99例患者使用。右心室梗阻与较低的E/A比值（P = 0.02）、E/A逆转（P = 0.02）以及舒张末期正向肺血流（P < 0.01）相关。三尖瓣环a'降低和室间隔s'降低与较低的右心室射血分数相关（P < 0.01，P < 0.01）。E/e'升高与较高的右心室舒张末期容积相关（P = 0.04）。在预测未来干预的任何评估危险因素的存在时，三尖瓣E/e'≥4.7的阳性预测值（PPV）为86%，阴性预测值（NPV）为50%，三尖瓣E/A逆转的PPV为89%，NPV为34%，超声心动图上舒张末期正向肺血流的PPV为91%，NPV为38%。
舒张功能障碍的超声心动图参数在预测CMR所确定的具有临床意义的危险因素方面具有合理的PPV，但NPV较差。
