Congenital Heart Disease Unit, Cardiology Department, Tanta University, Tanta, Egypt.
Echocardiography. 2020 Dec;37(12):2091-2101. doi: 10.1111/echo.14924. Epub 2020 Nov 16.
The systemic load on the right ventricle (RV) after Senning atrial switch leads to ventricular dysfunction. Quantitative assessment of RV contractile reserve is mandatory to anticipate the need for anti-fibrotic treatment. We aimed to quantitatively assess RV contractile reserve in Senning children by estimating speckle-based global longitudinal strain (GLS) during dobutamine stress echocardiography (DSE).
This prospective study compared thirty-one post-Senning children (group I) and thirty controls (group II). In post-Senning children, echocardiographic RV systolic function using one-plane ejection fraction (RVEF), RV fractional area change (RVFAC), tricuspid annulus plane systolic excursion (TAPSE), its Z-score, and RVGLS were recorded at rest and peak DSE. Contractile reserve was defined as improvement >5% in RVEF, >2% in GLS, and/or to near normal TAPSE.
RVEF, RVFAC, TAPSE, and TAPSE Z-score were significantly lower in patients than controls [RVEF:40.13 ± 2.93% vs 53.17 ± 3.17% (P < .001*), RVFAC: 21.17 ± 2.37% vs 37.23 ± 2.13% (P < .001*), TAPSE:13.81 ± 1.26 vs 17.45 ± 2.93 mm (P < .001*), TAPSE Z-score: -3.47 ± 0.46 vs -2.09 ± 0.48 (P < .001*)]. Also, RVGLS was significantly impaired in Senning children than controls[ (-11.89 ± 2.31% vs -22.35 ± 6.73% (P < .001*)]. At peak DSE, contractile reserve was not evident as measured by RVEF which increased none significantly to 42.47 ± 2.80% (P = .063). However, RVGLS improved significantly to -15.78 ± 0.93% (P < .001*) and discovered the masked contractile reserve in Senning children. The 19(61.29%) children who showed masked contractile reserve (improvement in RVGLS > 2%) underwent continuation of anti-fibrotic medications.
Despite systemic RV function in post-Senning children was impaired at rest and during DSE, RVGLS was useful in quantitative assessment of masked contractile thus promoted continuing anti-fibrotic treatment.
法洛四联症根治术后右心室（RV）的系统性负荷导致心室功能障碍。定量评估 RV 收缩储备对于预测抗纤维化治疗的需求至关重要。我们旨在通过估计多巴酚丁胺负荷超声心动图（DSE）期间斑点追踪的整体纵向应变（GLS）来定量评估 Senning 儿童的 RV 收缩储备。
这项前瞻性研究比较了 31 名 Senning 术后儿童（I 组）和 30 名对照组（II 组）。在 Senning 术后儿童中，在静息和多巴酚丁胺负荷达峰值时，使用单平面射血分数（RVEF）、RV 局部射血分数（RVFAC）、三尖瓣环平面收缩期位移（TAPSE）、其 Z 评分和 RVGLS 记录 RV 收缩功能。收缩储备定义为 RVEF 改善>5%、GLS 改善>2%和/或 TAPSE 接近正常。
与对照组相比，患者的 RVEF、RVFAC、TAPSE 和 TAPSE Z 评分明显较低[RVEF：40.13±2.93% vs 53.17±3.17%（P<0.001*），RVFAC：21.17±2.37% vs 37.23±2.13%（P<0.001*），TAPSE：13.81±1.26 vs 17.45±2.93mm（P<0.001*），TAPSE Z 评分：-3.47±0.46 vs -2.09±0.48（P<0.001*）]。此外，Senning 儿童的 RVGLS 明显受损，比对照组的[（-11.89±2.31% vs -22.35±6.73%（P<0.001*）]。在多巴酚丁胺负荷达峰值时，RVEF 无明显增加，收缩储备不明显，为 42.47±2.80%（P=0.063）。然而，RVGLS 显著改善至-15.78±0.93%（P<0.001*），并发现 Senning 儿童存在隐匿性收缩储备。19 名（61.29%）表现出隐匿性收缩储备（RVGLS 改善>2%）的儿童继续接受抗纤维化药物治疗。
尽管 Senning 术后儿童的右心室系统功能在静息和多巴酚丁胺负荷时受损，但 RVGLS 可用于定量评估隐匿性收缩储备，从而促进继续抗纤维化治疗。
