Matsubara Daisuke, Numata Ryusuke, Calderon-Anyosa Renzo, Kauffman Hunter L, Biko David M, Pedrizzetti Gianni, Banerjee Anirban
Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Eur Heart J Imaging Methods Pract. 2025 May 13;3(3):qyaf050. doi: 10.1093/ehjimp/qyaf050. eCollection 2024 Aug.
Principal strain (PS) analysis using 3D speckle-tracking echocardiography enables us to simultaneously measure 3D ventricular volumes and strains. PS quantifies 3D deformation by defining not only amplitude but also direction of principal myocardial contraction (PS angle). This study aims (i) to validate volumetric and functional parameters using PS analysis in volume-overloaded right ventricle (RV) of repaired tetralogy of Fallot (rTOF) vs. cardiac magnetic resonance (CMR) and (ii) to describe PS analysis indices in patients undergoing pulmonary valve replacement (PVR).
Sixty-four paediatric patients with rTOF (12.4 ± 5.2 years) and 58 age-matched healthy children (12.8 ± 3.7 years) were prospectively included. We calculated PS magnitude [global PS (GPS)] and angle, indexed RV end-diastolic and end-systolic volumes (EDVi and ESVi), RV ejection fraction (EF), and conventional strains. Among rTOF patients, 32 CMRs were available. First, we validated volumetric parameters obtained by PS analysis against CMR. Second, we compared these indices between rTOF patients and controls. Lastly, we evaluated the discriminative value of PS analysis in PVR. PS analysis and CMR measurements showed good correlations (EDVi, = 0.80; ESVi, = 0.74; and EF, = 0.70, < 0.001). GPS showed the highest correlation with 3D-EF ( = -0.84, < 0.001). rTOF patients exhibited nearly doubled RV volume and significantly decreased 3D-EF and conventional strains. PS magnitude also decreased in rTOF patients, with altered PS angles in RV free wall. Volume measurements of RV showed the highest predictive value for discriminating PVR (+) by receiver operating characteristic analysis, followed by PS functional parameters.
PS analysis is a reliable and reproducible method for both volumetric and functional analysis of volume-overloaded RV in rTOF, which can be of incremental value for defining the indications for PVR.
使用三维斑点追踪超声心动图进行主应变（PS）分析，使我们能够同时测量三维心室容积和应变。PS通过定义心肌主收缩的幅度和方向（PS角）来量化三维变形。本研究旨在：（i）在法洛四联症修复术后（rTOF）容量超负荷的右心室（RV）中，使用PS分析验证容积和功能参数，并与心脏磁共振成像（CMR）进行比较；（ii）描述接受肺动脉瓣置换术（PVR）患者的PS分析指标。
前瞻性纳入64例rTOF儿科患者（12.4±5.2岁）和58例年龄匹配的健康儿童（12.8±3.7岁）。我们计算了PS大小[整体PS（GPS）]和角度、右心室舒张末期和收缩末期容积指数（EDVi和ESVi）、右心室射血分数（EF）以及传统应变。在rTOF患者中，有32例可进行CMR检查。首先，我们将PS分析获得的容积参数与CMR进行验证。其次，我们比较了rTOF患者与对照组之间的这些指标。最后，我们评估了PS分析在PVR中的鉴别价值。PS分析和CMR测量显示出良好的相关性（EDVi，r = 0.80；ESVi，r = 0.74；EF，r = 0.70，P < 0.001）。GPS与三维EF的相关性最高（r = -0.84，P < 0.001）。rTOF患者的右心室容积几乎增加了一倍，三维EF和传统应变显著降低。rTOF患者的PS大小也降低，右心室游离壁的PS角度发生改变。通过受试者工作特征分析，右心室容积测量对鉴别PVR（+）的预测价值最高，其次是PS功能参数。
PS分析是一种可靠且可重复的方法，可用于rTOF中容量超负荷右心室的容积和功能分析，对于确定PVR的适应证可能具有额外价值。
