39 Transthoracic echocardiography (echo) versus cardiac magnetic resonance (cmr) in assessment of the right ventricle (rv) systolic function in patients with repaired tetralogy of fallot (tof). is there any correlation between tricuspid annular plane systolic excursion (tapse) from m-mode, tricuspid annular systolic motion from tissue doppler imaging (rv sa) in echo and the right ventricle (rv) ejection fraction in cmr? results from a uk centre

AbstractBackgroundPatients with a congenitally corrected transposition of the great arteries show an increasing incidence of cardiac failure with age. In other systemic right ventricles, such as in dextro-transposition after atrial switch, excessive hypertrophy is a potential risk factor for impaired systolic function. In this trial, we sought to compare systemic function and volumes between patients with congenitally corrected transposition and those with dextro-transposition after atrial switch by using cardiac magnetic resonance imaging.Methods and ResultsA total of 19 patients (nine male) with congenitally corrected transposition and 31 patients (21 male) with dextro-transposition after atrial switch were studied using a 1.5-Tesla scanner. Cine steady-state free-precession sequences in standard orientations were acquired for volumetric and functional imaging. Patient parameters were compared with those of a group of 25 healthy volunteers. Although patients with congenitally corrected transposition were older, they presented with higher right ventricular ejection fractions (p = 0.04) compared with patients with dextro-transposition. Patients with congenitally corrected transposition showed a weak negative correlation between age at examination and systemic ejection fraction (r = −0.18, p = 0.04) but no correlation between right ventricular myocardial mass index and ejection fraction. There was no significant difference in the right ventricular end-diastolic volumes between both patient groups.ConclusionAlthough patients with congenitally corrected transposition had a longer pressure load of the systemic right ventricle, ventricular function was better compared with that in patients with dextro-transposition after atrial switch. The results suggest that the systemic ventricles might have partly different physiologies. One difference could be the post-operative situation after atrial switch, which results in impaired atrial contribution to ventricular filling.

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Late gadolinium-enhanced cardiac magnetic resonance in repaired tetralogy of Fallot: characterization of the right ventricular arrhythmogenic substrate

European Heart Journal ◽

10.1093/ehjci/ehaa946.2187 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Rodriguez Garcia ◽

A Pijuan Domenech ◽

G Pascual Gonzalez ◽

L Dos Subira ◽

J Perez Rodon ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Right Ventricle ◽

Tetralogy Of Fallot ◽

Linear Correlation ◽

High Density ◽

Arrhythmogenic Substrate ◽

The Right ◽

Lge Cmr

Abstract Introduction Ventricular arrhythmias are one of the main causes of morbidity and mortality in patients with repaired tetralogy of fallot (rTF). These life-threatening arrhythmias are related to specific isthmuses of viable tissue between areas of scar and/or valve rings of the right ventricle (RV) that have been already described in the literature. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) has proven useful in characterizing the arrhythmogenic substrate in several heart diseases. Nevertheless, LGE-CMR evidence in patients with rTF is scarce. Purpose To compare the characterization of the ventricular arrhythmogenic substrate by means of LGE-CMR and electroanatomic mapping (EAM) of the right ventricle (RV) in patients with rTF. Methods Unicentric and observational study of consecutive patients with rTF who underwent LGE-CMR performed with 1.5T equipment and RV high-density voltage map, performed with multipolar catheter and completed with contact force-sensing catheter. The LGE-CMR segmentation was performed with dedicated software. The extent (area and percentage) and location of the dense scar (defined as <0.5 mV in EAM and <40% of the maximum intensity pixel in LGE-CMR) were compared, as well as the location of the isthmuses of viable tissue. Results Eight patients were included (45.7±10.4 years; 50% male). The extent of the scar was 20.7±13.6 cm2 (15.1±9.3%) by EAM and 21.7±8.8 cm2 (11.8±7.6%) by LGE-CMR. There was an absolute correlation regarding the location of the dense scar and the distribution of the isthmuses of viable tissue. The quantification of the dense scar evidenced a positive linear correlation between both techniques (area correlation: ρ = 0.71, p=0.047; percentage correlation: ρ = 0.88; p=0.004). The average time spent for the segmentation of the LGE-CMR with the dedicated software was 19.9±3.0 minutes. Conclusions Characterization of the RV arrhythmogenic substrate in patients with rTF with LGE-CMR is feasible. An absolute association regarding the location of the dense scar and the distribution of the isthmuses of viable tissue was observed when compared to the RV high-density EAM. In the same way, a statistically significant linear correlation in the quantification of the dense scar between both techniques was documented. LGE-CMR and EAM of two patients with rTF Funding Acknowledgement Type of funding source: None

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Mechanical-electrical interaction of the right ventricle in patients with repaired tetralogy of fallot: the next step towards resynchronization in congenital heart disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.2214 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Rodriguez Garcia ◽

A Pijuan Domenech ◽

J Perez Rodon ◽

B Benito Villabriga ◽

J Francisco Pascual ◽

...

Keyword(s):

Heart Disease ◽

Ejection Fraction ◽

Right Ventricle ◽

Tetralogy Of Fallot ◽

Negative Correlation ◽

Electrical Activation ◽

Basal Region ◽

Repaired Tetralogy Of Fallot ◽

The Right ◽

Activation Delay

Abstract Introduction Patients with repaired tetralogy of Fallot (rTF) and severe pulmonary regurgitation frequently progress to dilation and dysfunction of the right ventricle (RV). It has been documented in the literature that there is a correlation between the duration of the QRS in the surface electrocardiogram and the hemodynamic parameters of the RV of these patients, suggesting the presence of a mechanical-electrical interaction. Purpose To determine if there is an association between the contraction delay in certain areas of the RV measured in M-mode echocardiography and the delay in electrical activation measured in the electroanatomic map (EAM) of RV in patients with rTF. Methods Unicentric and observational study of all patients with rTF undergoing EAM, echocardiography with study of RV asynchrony and cardiac magnetic resonance imaging (MRI). Activation delay in the antero-basal area and in the RV outflow tract (RVOT) in the EAM were both analysed (Figure 1A). The shortening delay in the same areas in M-mode echocardiography was also evaluated (Figure 1B, C). MRI data regarding volume and ejection fraction was also collected. Results 64 patients were included (36.7±10.6 years, 65% men). The mean total activation time of the RV (RV-TAT) was 127.3±42.4 ms. Activation mapping showed a recurrent pattern with beginning in the interventricular septum and ending in RV antero-basal region and/or RVOT. A linear positive correlation was observed between RV-TAT and the activation delay in both regions analysed (ρ=0.60 and ρ=0.52, respectively; p<0.001) and also between the electrical and mechanical delay in the anterior wall (ρ=0.41; p=0.001). On the other hand, it was observed a negative correlation between RV ejection fraction (RVEF), measured on MRI, and the RV-TAT (ρ=−0.41, p=0.002) and also between RVEF and the activation delay in the RV antero-basal region and in the RVOT (ρ=−0.32, p=0.016 and ρ=−0.36, p=0.007, respectively). Conclusions There is a mechanical-electrical interaction in the RV of patients with rTF, with a negative correlation between the activation delay and RVEF and between mechanical and electrical activation delay in specific anatomical regions (regional mechanical-electrical interaction). These results may guide future studies on resynchronization in this heart disease. Figure 1. EAM and echocardiographic measures Funding Acknowledgement Type of funding source: None

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INSTRUMENTAL MARKERS OF THE RIGHT VENTRICLE FUNCTIONAL CONDITION WITH TISSUE DOPPLER IN CHILDREN WITH TETRALOGY OF FALLOT AFTER SURGICAL CORRECTION AND THEIR CONNECTION WITH VALVULAR FUNCTION OF PULMONARY ARTERY

Wiadomości Lekarskie ◽

10.36740/wlek202011108 ◽

2020 ◽

Vol 73 (11) ◽

pp. 2364-2369

Author(s):

Veronika M. Dudnyk ◽

Olha O. Zborovska ◽

Yuilia V. Vyzhga ◽

Vladymyr P. Popov ◽

Valentyn S. Bakhnivskyi

Keyword(s):

Right Ventricle ◽

Tetralogy Of Fallot ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Pulmonary Regurgitation ◽

Functional Condition ◽

Tissue Doppler ◽

Surgical Correction ◽

Heart Cycle ◽

The Right

The aim: To improve efficacy of the right ventricle functional condition evaluation in children with tetralogy of Fallot after surgical correction by estimation of instrumental markers of myocardial dysfunction. Materials and methods: We completely examined 35 children with tetralogy of Fallot after their surgical correction at the age of 3 – 17 years. For all the patients was presented tissue doppler. We evaluated peak myocardial velocities of right ventrical in different phases of the heart cycle (S, E`, A`), tricuspid annular plane systolic excursion (TAPSE), diastolic myocardial velocities ratio (E/E`), peak myocardial velocity during isovolumic contraction (IVV), isovolumic relaxation time (IVRT). Results: All children of the study group had pulmonary insufficiency of different severity with main predominance of mild pulmonary regurgitation (20 patients, 57,14±8,36 %). Children with tetralogy of Fallot after surgical correction were admitted with: decreased TAPSE up to 1,39±0,28 cm, decreased S` up to 8,00±1,90 cm/s, and decreased IVV up to 5,69±0,95 cm/s that is significantly lower results of the healthy children. Severe pulmonary regurgitation usually followed by high chances of the right ventricle systolic dysfunction, exactly with: decresed TAPSE<1,5 cm (OR=0,500; 95% CI 0,323 – 0,775), S`<8,1 cm/s (OR=0,600; 95% CI 0,420 – 0,858) and IVV<5,9 cm/s (OR=0,250; 95% CI 0,117 – 0,534). As well we admitted significant decline of the velocities in earl and end diastole periods to compare with the results of the control group (E`= 12,11±1,22, A`= 4,56±0,92 cm/s (Р=0,009 and P=0.0002)), boost of the E/E` ratio – 7,96±2,33 (P=0.01) and decline of the RV IVRT up to 43,49±6,04 ms (P=0.017). Severe pulmonary regurgitation followed by high chances of the right ventricle systolic dysfunction development with TAPSE <1,5 cm (OR=0,500; 95% CI 0,323 – 0,775), S`<8,1 cm/s (OR=0,600; 95% CI 0,420 – 0,858) and IVV<5,9 cm/s (OR=0,250; 95% CI 0,117 – 0,534). As well we noticed high chances of the E/E`ratio > 6,0 in 1,5 times (95% CI 1,072 – 1,903) and decreased E` <12,2 cm/s (OR=0,200; 95% CI 0,083 – 0,481). Conclusions: Apart of clinical symptoms of the heart failure in children with tetralogy of Fallot after surgical correction markers of the right ventricle myocardial dysfunction are presented by indices of myocardial velocities, received during tissue doppler in different phases of the heart cycle.

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Post-exertional increase in first-phase ejection fraction in recreational marathon runners

JRSM Cardiovascular Disease ◽

10.1177/2048004020926366 ◽

2020 ◽

Vol 9 ◽

pp. 204800402092636

Author(s):

Luca Faconti ◽

Iain Parsons ◽

Bushra Farukh ◽

Ryan McNally ◽

Lorenzo Nesti ◽

...

Keyword(s):

Ejection Fraction ◽

Tissue Doppler Imaging ◽

Systolic Function ◽

Tissue Doppler ◽

Left Ventricular ◽

Cardiac Performance ◽

Doppler Imaging ◽

Marathon Running ◽

Aortic Blood Flow ◽

Marathon Runners

Objectives Running a marathon has been equivocally associated with acute changes in cardiac performance. First-phase ejection fraction is a novel integrated echocardiographic measure of left ventricular contractility and systo-diastolic coupling which has never been studied in the context of physical activity. The aim of this study was to assess first-phase ejection fraction following recreational marathon running along with standard echocardiographic indices of systolic and diastolic function. Design and participants: Runners (n = 25, 17 males), age (mean ± standard deviation) 39 ± 9 years, were assessed before and immediately after a marathon race which was completed in 4 h, 10 min ± 47 min. Main outcome measures Central hemodynamics were estimated with applanation tonometry; cardiac performance was assessed using standard M-mode two-dimensional Doppler, tissue-doppler imaging and speckle-tracking echocardiography. First-phase ejection fraction was calculated as the percentage change in left ventricular volume from end-diastole to the time of peak aortic blood flow. Results Conventional indices of systolic function and cardiac performance were similar pre- and post-race while aortic systolic blood pressure decreased by 9 ± 8 mmHg ( P < 0.001) and first-phase ejection fraction increased by approximately 48% from 16.3 ± 3.9% to 22.9 ± 2.5% ( P < 0.001). The ratio of left ventricular transmitral Doppler early velocity (E) to tissue-doppler imaging early annular velocity (e′) increased from 5.1 ± 1.8 to 6.2 ± 1.3 ( P < 0.01). Conclusion In recreational marathon runners, there is a marked increase in first-phase ejection fraction after the race despite no other significant change in cardiac performance or conventional measure of systolic function. More detailed physiological studies are required to elucidate the mechanism of this increase.

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