Zhao Xiaodan, Lee Phong Teck, Hu Liwei, Tan Ru-San, Chai Ping, Yeo Tee Joo, Leng Shuang, Ouyang RongZhen, Bryant Jennifer Ann, Teo Lynette L S, van der Geest Rob J, Yip James W, Tan Ju Le, Zhong Yumin, Zhong Liang
National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.
Duke-NUS Medical School, Singapore.
JACC Asia. 2024 Oct 22;4(12):912-924. doi: 10.1016/j.jacasi.2024.08.019. eCollection 2024 Dec.
Right ventricular restrictive physiology (RVRP) is a common occurrence in repaired tetralogy of Fallot (rTOF). The relationship of RVRP with biventricular blood flow components and kinetic energy (KE) from 4-dimensional (4D) flow cardiovascular magnetic resonance (CMR) is unclear.
The purpose of this study was to investigate the association of 4D flow CMR parameters with RVRP in rTOF patients.
A total of 103 rTOF patients and 62 age and sex-matched healthy control subjects were prospectively recruited. All participants underwent CMR (cine, 2-dimensional phase-contrast, and 4D flow sequences), and cardiopulmonary exercise test in adult populations. RVRP was identified from pulmonary artery flow curve using 2-dimensional phase-contrast images. Biventricular flow components (direct flow, retained inflow, delayed ejection flow, and residual volume) and KE parameters normalized to end-diastolic volume (KEi) were analyzed encompassing global, peak systolic, average systolic, average diastolic, peak E-wave, and peak A-wave.
Compared with control subjects, rTOF patients had significantly lower RV direct flow and higher RV residual volume (both 0.001). All RV KEi parameters, except peak A-wave, were higher in rTOF patients. In rTOF patients, 70 of 103 (68%) had RVRP, with increasing RV direct flow (27% vs 20%; 0.002) and RV peak E-wave KEi (28.4 vs 20.7μJ/mL; 0.015) and decreasing RV residual volume (37% vs 42%; 0.039) than rTOF without RVRP. Exercise capacity was impaired in rTOF, although comparable between RVRP subgroups. Multivariable analysis revealed RV direct flow was an independent predictor of RVRP (OR: 1.158; 95% CI: 1.074-1.249; < 0.001).
RVRP is associated with dilated RV, higher pulmonary regurgitation, and higher RV direct flow. (Integrated Computational modeling of Right Heart Mechanics and Blood Flow Dynamics in Congenital Heart Disease; NCT03217240).
右心室限制性生理（RVRP）在法洛四联症修复术后（rTOF）中很常见。RVRP与来自四维（4D）血流心血管磁共振（CMR）的双心室血流成分和动能（KE）之间的关系尚不清楚。
本研究旨在探讨rTOF患者中4D血流CMR参数与RVRP之间的关联。
前瞻性招募了103例rTOF患者和62例年龄及性别匹配的健康对照者。所有参与者均接受了CMR（电影、二维相位对比和4D血流序列）检查以及成人心肺运动试验。使用二维相位对比图像从肺动脉血流曲线中识别出RVRP。分析双心室血流成分（直接血流、保留流入、延迟射血血流和残余容积）以及以舒张末期容积标准化的KE参数（KEi），包括整体、收缩期峰值、平均收缩期、平均舒张期、E波峰值和A波峰值。
与对照者相比，rTOF患者的右心室直接血流显著降低，右心室残余容积显著升高（均P<0.001）。rTOF患者中，除A波峰值外的所有右心室KEi参数均更高。在rTOF患者中，103例中有70例（68%）存在RVRP，与无RVRP的rTOF患者相比，其右心室直接血流增加（27%对20%；P=0.002）、右心室E波峰值KEi升高（28.4对20.7μJ/mL；P=0.015）且右心室残余容积降低（37%对42%；P=0.039）。rTOF患者的运动能力受损，尽管在RVRP亚组之间具有可比性。多变量分析显示右心室直接血流是RVRP的独立预测因素（OR：1.158；95%CI：1.074-1.249；P<0.001）。
RVRP与右心室扩张、更高的肺动脉反流和更高的右心室直接血流相关。（先天性心脏病右心力学和血流动力学的综合计算建模；NCT03217240）
