Moya Ana, Verstreken Sofie, Buytaert Dimitri, Beles Monika, Oliveira Elayne Kelen de, Vanderheyden Marc, Van De Bruaene Alexander, Budts Werner
CardioPath PhD Program, Federico II University Hospital, Naples, Italy.
Cardiovascular Research Centre Aalst, Aalst, Belgium.
Int J Cardiol Congenit Heart Dis. 2024 Aug 14;18:100537. doi: 10.1016/j.ijcchd.2024.100537. eCollection 2024 Dec.
The Mustard and Senning operations for dextro-transposition of the great arteries (D-TGA) establish a biventricular physiology with a subaortic right ventricle (sRV). While prolonged QRS has been associated with worse prognosis in these patients, current echocardiographic tools fall short in adequately assessing the (mal)performance and function decline of the sRV during follow-up. The present study is the first to characterize Myocardial Work (MW) indices of the sRV in D-TGA patients after Mustard/Senning repair.
All adult D-TGA patients at follow-up in the University Hospital of Leuven between 2018 and 2022 were screened for inclusion. We retrospectively collected the most recent electrocardiogram parameters, 2D echocardiographic images and serum biomarkers' values. Offline calculations of MW indices were performed. We established correlations between all variables and categorized patients into QRS<120 ms and QRS≥120 ms for further analysis. A total of 51 D-TGA patients were included (13 Mustard, 33 male, 39 ± 6 years). QRS duration increased with age and was correlated with sRV dimensions and serum levels of troponins (R = 0.42, p < 0.01) and NT-proBNP (R = 0.31, p = 0.03). However, no significant correlation was found between QRS duration and intraventricular desynchrony or conventional functional echocardiographic parameters. QRS prolongation was associated with a deterioration in septal, but not lateral, MW parameters. Patients with QRS≥120 ms had significantly larger ventricles and higher levels of troponins and NT-proBNP.
QRS prolongation after Mustard/Senning repair is linked to ventricular dilatation and worse performance, particularly affecting the septal wall. Global and regional MW analysis may be useful to assess the subclinical deterioration of sRV function.
用于大动脉右位转位（D-TGA）的Mustard手术和Senning手术建立了一种具有主动脉下右心室（sRV）的双心室生理状态。虽然QRS波增宽与这些患者较差的预后相关，但目前的超声心动图工具在充分评估随访期间sRV的（不良）性能和功能下降方面存在不足。本研究首次对Mustard/Senning修复术后D-TGA患者的sRV心肌做功（MW）指标进行了特征描述。
对2018年至2022年期间在鲁汶大学医院接受随访的所有成年D-TGA患者进行筛选以纳入研究。我们回顾性收集了最新的心电图参数、二维超声心动图图像和血清生物标志物值。进行了MW指标的离线计算。我们建立了所有变量之间的相关性，并将患者分为QRS<120 ms和QRS≥120 ms两组进行进一步分析。共纳入51例D-TGA患者（13例行Mustard手术，33例男性，39±6岁）。QRS波时限随年龄增加而延长，且与sRV大小以及肌钙蛋白（R = 0.42，p < 0.01）和N末端B型利钠肽原（NT-proBNP）（R = 0.31，p = 0.03）的血清水平相关。然而，未发现QRS波时限与心室内不同步或传统的超声心动图功能参数之间存在显著相关性。QRS波增宽与间隔而非侧壁的MW参数恶化相关。QRS≥120 ms的患者心室明显更大，肌钙蛋白和NT-proBNP水平更高。
Mustard/Senning修复术后QRS波增宽与心室扩张和功能恶化有关，尤其影响间隔壁。整体和局部MW分析可能有助于评估sRV功能的亚临床恶化。
