Surkova Elena, Kovács Attila, Lakatos Bálint Károly, Tokodi Márton, Fábián Alexandra, West Cathy, Senior Roxy, Li Wei
Department of Echocardiography, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, UK.
Echocardiography Core Laboratory, Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest H-1122, Hungary.
Eur Heart J Cardiovasc Imaging. 2022 Nov 17;23(12):1654-1662. doi: 10.1093/ehjci/jeab272.
To investigate contraction patterns of the systemic right ventricle (SRV) in patients with transposition of great arteries (TGA) post-atrial switch operation and with congenitally corrected transposition of great arteries (ccTGA).
Right ventricular (RV) volumes and ejection fraction (EF) were measured by three-dimensional echocardiography in 38 patients with the SRV (24 TGA and 14 ccTGA; mean age 45 ± 12 years, 63% male), and in 38 healthy volunteers. The RV contraction was decomposed along the longitudinal, radial, and anteroposterior directions providing longitudinal, radial, and anteroposterior EF (LEF, REF, and AEF, respectively) and their contributions to total right ventricular ejection fraction (LEFi, REFi, and AEFi, respectvely). SRV was significantly larger with lower systolic function compared with healthy controls. SRV EF and four-chamber longitudinal strain strongly correlated with B-type natriuretic peptide (BNP) level (Rho -0.73, P < 0.0001 and 0.70, P < 0.0001, respectively). In patients with TGA, anteroposterior component was significantly higher than longitudinal and radial components (AEF 17 ± 4.5% vs. REF 13 ± 4.9% vs. LEF 10 ± 3.3%, P < 0.0001; AEFi 0.48 ± 0.09 vs. REFi 0.38 ± 0.1 vs. LEFi 0.29 ± 0.08, P < 0.0001). In patients with ccTGA, there was no significant difference between three SRV components. AEFi was significantly higher in TGA subgroup compared with ccTGA (0.48 ± 0.09 vs. 0.36 ± 0.08, P = 0.0002).
Contraction patterns of the SRV are different in TGA and ccTGA. Anteroposterior component is dominant in TGA providing compensation for impaired longitudinal and radial components, while in ccTGA all components contribute equally to the total EF. SRV EF and longitudinal strain demonstrate strong correlation with BNP level and should be a part of routine echocardiographic assessment of the SRV.
研究大动脉转位（TGA）心房调转术后患者及先天性矫正型大动脉转位（ccTGA）患者的体循环右心室（SRV）收缩模式。
采用三维超声心动图测量38例SRV患者（24例TGA和14例ccTGA；平均年龄45±12岁，63%为男性）及38例健康志愿者的右心室（RV）容积和射血分数（EF）。RV收缩沿纵向、径向和前后方向进行分解，分别得出纵向、径向和前后向EF（分别为LEF、REF和AEF）及其对右心室总射血分数的贡献（分别为LEFi、REFi和AEFi）。与健康对照组相比，SRV明显更大，收缩功能更低。SRV EF和四腔心纵向应变与B型利钠肽（BNP）水平密切相关（Rho分别为-0.73，P<0.0001和0.70，P<0.0001）。在TGA患者中，前后向分量明显高于纵向和径向分量（AEF 17±4.5%对REF 13±4.9%对LEF 10±3.3%，P<0.0001；AEFi 0.48±0.09对REFi 0.38±0.1对LEFi 0.29±0.08，P<0.0001）。在ccTGA患者中，SRV的三个分量之间无显著差异。TGA亚组的AEFi明显高于ccTGA（0.48±0.09对0.36±0.08，P=0.0002）。
TGA和ccTGA患者的SRV收缩模式不同。TGA中前后向分量占主导，可对受损的纵向和径向分量起到补偿作用，而在ccTGA中，所有分量对总EF的贡献相同。SRV EF和纵向应变与BNP水平密切相关，应成为SRV常规超声心动图评估的一部分。
