Koopman L P, Geerdink L M, Bossers S S M, Duppen N, Kuipers I M, Ten Harkel A D, van Iperen G, Weijers G, de Korte C, Helbing W A, Kapusta L
Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatric Cardiology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands.
Pediatr Cardiol. 2018 Feb;39(2):283-293. doi: 10.1007/s00246-017-1753-z. Epub 2017 Oct 25.
Survival of children with single ventricle heart defects after the total cavopulmonary connection (TCPC) has improved, but impaired cardiac function remains a major cause of morbidity and mortality. Cardiac magnetic resonance imaging (cMRI) is the gold standard in assessing single ventricle volume and function, but high costs and limited availability hamper its routine use. A cheaper and more available alternative is echocardiography. Myocardial function can be studied in more detail using speckle tracking echocardiography (STE). The purpose of the study was to describe the association between myocardial deformation assessed by speckle tracking echocardiography (STE) and single ventricle function assessed by cMRI and to evaluate differences in myocardial deformation in children with single left and single right ventricular morphology. Cross-sectional, multicenter study in 77 children after TCPC was conducted. STE segmental and global longitudinal peak strain and systolic strain rate (SR) of the dominant ventricle were measured. Impaired SV function by cMRI was defined as ejection fraction (EF) < 45%. Mean age was 11.8 (range 9.7-14.3) years. Pearson R for cMRI EF versus global longitudinal strain and SR was - 0.25 (p = 0.06) and - 0.03 (p = 0.82), respectively. Global single ventricle longitudinal strain and SR was similar in patients after TCPC with single left and single right ventricular morphology (- 19.0 ± 3.1% vs 19.2 ± 3.2%, p = 0.94). STE myocardial deformation parameters do not correlate with single ventricle ejection fraction assessed by cMRI.
全腔静脉肺动脉连接术（TCPC）后单心室心脏缺陷患儿的生存率有所提高，但心功能受损仍是发病和死亡的主要原因。心脏磁共振成像（cMRI）是评估单心室容积和功能的金标准，但成本高昂且可用性有限，阻碍了其常规应用。一种更便宜且更易获得的替代方法是超声心动图。使用斑点追踪超声心动图（STE）可以更详细地研究心肌功能。本研究的目的是描述通过斑点追踪超声心动图（STE）评估的心肌变形与通过cMRI评估的单心室功能之间的关联，并评估左单心室和右单心室形态患儿心肌变形的差异。对77例接受TCPC后的儿童进行了横断面、多中心研究。测量了优势心室的STE节段和整体纵向峰值应变以及收缩期应变率（SR）。cMRI显示的SV功能受损定义为射血分数（EF）<45%。平均年龄为11.8岁（范围9.7 - 14.3岁）。cMRI EF与整体纵向应变和SR的Pearson R分别为-0.25（p = 0.06）和-0.03（p = 0.82）。在接受TCPC后具有左单心室和右单心室形态的患者中，整体单心室纵向应变和SR相似（-19.0±3.1%对19.2±3.2%，p = 0.94）。STE心肌变形参数与cMRI评估的单心室射血分数不相关。
