Egbe Alexander C, Pislaru Sorin V, Kothapalli Srikanth, Jadav Raja, Masood Muhammad, Angirekula Mounika, Pellikka Patricia A
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Congenit Heart Dis. 2019 Sep;14(5):700-705. doi: 10.1111/chd.12783. Epub 2019 May 9.
Quantitative assessment of right ventricular (RV) systolic function by echocardiography is challenging in patients with congenital heart disease because of the complex geometry of the RV and the iatrogenic structural abnormalities resulting from prior cardiac surgeries. The purpose of this study was to determine the correlation between echocardiographic indices of RV systolic function and cardiac magnetic resonance imaging (CMRI) derived RV ejection fraction (RVEF) in adults with repaired tetralogy of Fallot (TOF).
Quantitative assessment of RV function was performed with RV tissue Doppler systolic velocity (RV s'), tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC). These echocardiographic indices were compared to RVEF from CMRI performed on the same day as echocardiogram.
Of 209 patients, the mean RV FAC was 39 ± 9%, TAPSE was 18 ± 4 mm, RV s' was 10 ± 2 cm/s, and RVEF was 40 ± 10%. There was a good correlation between TAPSE and RVEF (r = 0.79, P < .001), good correlation between RV s' and RVEF (r = 0.71, P < .001), and modest correlation between FAC and RVEF (r = 0.66, P < .001). TAPSE < 17 mm effectively discriminated between patients with RV systolic dysfunction defined as RVEF < 47% (sensitivity 81%, specificity 79%, area under the curve [AUC] 0.805). FAC < 40% was associated with RVEF < 47% (sensitivity 72%, specificity 63%, AUC 0.719). RV s' < 11 cm was associated with RVEF < 47% (sensitivity 83%, specificity 68%, AUC 0.798).
Despite the structural and functional abnormalities of the RV in patients with repaired TOF, quantitative assessment of RV systolic function by echocardiography is feasible and had good correlation with CMRI-derived RVEF.
对于先天性心脏病患者，由于右心室（RV）几何结构复杂以及既往心脏手术导致的医源性结构异常，通过超声心动图对右心室收缩功能进行定量评估具有挑战性。本研究的目的是确定法洛四联症（TOF）修复术后成人患者右心室收缩功能的超声心动图指标与心脏磁共振成像（CMRI）得出的右心室射血分数（RVEF）之间的相关性。
采用右心室组织多普勒收缩期速度（RV s'）、三尖瓣环平面收缩期位移（TAPSE）和面积变化分数（FAC）对右心室功能进行定量评估。将这些超声心动图指标与在超声心动图检查同一天进行的CMRI得出的RVEF进行比较。
在209例患者中，右心室平均FAC为39±9%，TAPSE为18±4mm，RV s'为10±2cm/s，RVEF为40±10%。TAPSE与RVEF之间存在良好相关性（r = 0.79，P <.001），RV s'与RVEF之间存在良好相关性（r = 0.71，P <.001），FAC与RVEF之间存在中等相关性（r = 0.66，P <.001）。TAPSE < 17mm能有效区分RVEF < 47%定义的右心室收缩功能障碍患者（敏感性81%，特异性79%，曲线下面积[AUC] 0.805）。FAC < 40%与RVEF < 47%相关（敏感性72%，特异性63%，AUC 0.719）。RV s' < 11cm与RVEF < 47%相关（敏感性83%，特异性68%，AUC 0.798）。
尽管TOF修复术后患者右心室存在结构和功能异常，但通过超声心动图对右心室收缩功能进行定量评估是可行的，且与CMRI得出的RVEF具有良好相关性。
