Schöber Anne R, Jerosch-Herold Michael, Wegner Philip, Gabbert Dominik D, Voges Inga, Scheewe Jens, Giertzsch Tobias, Kresoja Karl-Patrik, Artemenko Yevheniia, Rickers Carsten
Department of Cardiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Cardiovasc Diagn Ther. 2025 Feb 28;15(1):37-49. doi: 10.21037/cdt-24-494. Epub 2025 Feb 25.
Left ventricular, atrial and aortic dysfunction might be important disease drivers in patients with transposition of great arteries (TGA) that possibly influence pathophysiological processes beyond the underlying congenital disease. Therefore, this study aimed to assess their influence and relationship in TGA patients following arterial switch operation (ASO).
Patients with TGA after ASO were studied with cardiac magnetic resonance imaging (CMR) to measure (I) extracellular volume fraction (ECV); (II) global peak systolic longitudinal strain (GLS); (III) left atrial reservoir function (LA-EF-reservoir) and (IV) aortic distensibility (AD). Mediation analysis was performed to model the interplay of ventricular, atrial and aortic function.
Eighty-one TGA patients (median age 16 years, 32% female) and 30 heart-healthy controls were included. TGA patients had significantly lower LA-EF-reservoir function (P<0.001) resulting in a shift from active to passive LA function (P<0.001), and AD was impaired in TGA patients (P<0.001). The ratio of active to passive LA function correlated with ECV (P=0.002). Both LA-EF-reservoir and AD correlated negatively with peak systolic GLS. In a mediation model, the effect of AD on peak systolic GLS encompassed both a direct effect on peak GLS (β=-0.2833), and an indirect effect mediated by LA-EF-reservoir (β=0.2087). LA-EF-reservoir had the strongest effect on ventricular function (β=-0.3193) and mediated 29% of the effect of AD on ventricular function (mediated β=-0.066).
Post ASO, impaired LA function and AD are associated with reduced systolic left ventricular function. These relationships are mediated through both direct effects, such as the direct impact of AD on GLS, and indirect pathways, including the mediating role of LA-EF reservoir function. Consequently, impaired left atrial and aortic function should be viewed not as isolated abnormalities but as interconnected physiological processes that jointly contribute to altered ventricular performance.
左心室、心房及主动脉功能障碍可能是大动脉转位（TGA）患者重要的疾病驱动因素，可能影响潜在先天性疾病之外的病理生理过程。因此，本研究旨在评估动脉调转术（ASO）后这些因素在TGA患者中的影响及关系。
对接受ASO后的TGA患者进行心脏磁共振成像（CMR）检查，以测量：（I）细胞外容积分数（ECV）；（II）整体峰值收缩期纵向应变（GLS）；（III）左心房储血功能（LA-EF-储血）；（IV）主动脉扩张性（AD）。进行中介分析以模拟心室、心房和主动脉功能之间的相互作用。
纳入81例TGA患者（中位年龄16岁，32%为女性）和30例心脏健康对照者。TGA患者的LA-EF-储血功能显著降低（P<0.001），导致左心房功能从主动型向被动型转变（P<0.001），且TGA患者的AD受损（P<0.001）。主动与被动左心房功能之比与ECV相关（P=0.002）。LA-EF-储血和AD均与峰值收缩期GLS呈负相关。在中介模型中，AD对峰值收缩期GLS的影响包括对峰值GLS的直接影响（β=-0.2833）以及由LA-EF-储血介导的间接影响（β=0.2087）。LA-EF-储血对心室功能的影响最强（β=-0.3193），并介导了AD对心室功能29%的影响（中介β=-0.066）。
ASO后，左心房功能受损和AD与左心室收缩功能降低相关。这些关系通过直接效应（如AD对GLS的直接影响）和间接途径（包括LA-EF储血功能的中介作用）介导。因此，左心房和主动脉功能受损不应被视为孤立的异常，而应被视为相互关联的生理过程，共同导致心室功能改变。
