Depts of Cardiology, Cardiac Surgery and Radiology, Sapienza University, Rome, Italy.
Cardiodiagnostica, via Lima 35, Rome, 00198, Italy.
Int J Cardiovasc Imaging. 2023 Sep;39(9):1631-1641. doi: 10.1007/s10554-023-02857-3. Epub 2023 Jul 5.
We aimed to comprehensively analyze by three-dimensional speckle-tracking echocardiography (3DSTE) and Doppler echocardiography right ventricular (RV) performance, pulmonary arterial (PA) elastic properties and right ventricular-pulmonary artery coupling (RVPAC) in patients with repaired tetralogy of Fallot (rTOF) and assess the feasibility and clinical utility of related echocardiographic indices. Twenty-four adult patients with rTOF and twenty-four controls were studied. RV end-diastolic volume(3D-RVEDV), RV end-systolic volume(3D-RVESV), RV ejection fraction(3D-RVEF), RV longitudinal strain(3D-RVLS) and RV area strain(3D-RVAS) were calculated by 3DSTE. RV end-systolic area (RVESA) was obtained by planimetry. Pulmonary regurgitation (PR) was assessed as trivial/mild or significant by cardiac magnetic resonance (CMR) and color-Doppler. Pulmonary artery (PA) elastic properties were determined using two-dimensional/Doppler echocardiography. RV systolic pressure (RVSP) was measured using standard Doppler methods. RVPAC was assessed using various 3DSTE-derived parameters (3DRVAS/RVSP, 3DRVLS/RVESA, 3DRVAS/RVESV). Overall, 3DRVEF and 3DRVAS were impaired in rTOF patients compared with controls. PA pulsatility and capacitance were reduced (p = 0.003) and PA elastance was higher (p = 0.0007) compared to controls. PA elastance had a positive correlation with 3DRVEDV (r = 0.64, p = 0.002) and 3DRVAS (r = 0.51, p = 0.02). By ROC (receiver operating characteristics) analysis, 3DRVAS/RVESV, 3DRVAS/RVSP and 3DRVLS/RVESA cutoff values of 0.31%/mmHg, 0.57%/mmHg and 0.86%/mmHg, respectively, had 91%, 88% and 88% sensitivity and 81%, 81% and 79% specificity in identifying exercise capacity impairment. In rTOF patients increased 3DSTE-derived RV volumes and impaired RV ejection fraction and strain are associated with reduced PA pulsatility and capacitance and increased PA elastance. 3DSTE-derived RVPAC parameters using different afterload-markers are accurate indices of exercise capacity.
我们旨在通过三维斑点追踪超声心动图（3DSTE）和多普勒超声心动图全面分析右心室（RV）、肺动脉（PA）的弹性特性和右心室-肺动脉偶联（RVPAC），以评估相关超声心动图指标的可行性和临床实用性。我们研究了 24 例修复性法洛四联症（rTOF）成年患者和 24 例对照者。通过 3DSTE 计算 RV 舒张末期容积（3D-RVEDV）、RV 收缩末期容积（3D-RVESV）、RV 射血分数（3D-RVEF）、RV 纵向应变（3D-RVLS）和 RV 面积应变（3D-RVAS）。通过平面法获取 RV 收缩末期面积（RVESA）。使用心脏磁共振（CMR）和彩色多普勒评估肺动脉反流（PR）为轻度/中度或重度。使用二维/多普勒超声心动图确定 PA 弹性特性。使用标准多普勒方法测量 RV 收缩压（RVSP）。使用各种 3DSTE 衍生参数（3DRVAS/RVSP、3DRVLS/RVESV、3DRVAS/RVESV）评估 RVPAC。与对照组相比，rTOF 患者的 3DRVEF 和 3DRVAS 均受损。PA 搏动性和顺应性降低（p=0.003），PA 弹性增加（p=0.0007）。PA 弹性与 3DRVEDV（r=0.64，p=0.002）和 3DRVAS（r=0.51，p=0.02）呈正相关。通过 ROC（接受者操作特征）分析，3DRVAS/RVESV、3DRVAS/RVSP 和 3DRVLS/RVESV 的截断值分别为 0.31%/mmHg、0.57%/mmHg 和 0.86%/mmHg，在识别运动能力受损方面，敏感性分别为 91%、88%和 88%，特异性分别为 81%、81%和 79%。在 rTOF 患者中，3DSTE 衍生的 RV 容积增加和射血分数受损与 PA 搏动性和顺应性降低以及 PA 弹性增加有关。使用不同后负荷标志物的 3DSTE 衍生的 RVPAC 参数是运动能力的准确指标。
