Key result
Patients with repaired tetralogy of Fallot, both with and without pulmonary valve replacement, had significantly reduced left ventricular global 3D strain compared to healthy controls.
Why the study?
Does three-dimensional speckle tracking echocardiography reveal impaired left ventricular mechanics in patients with repaired Tetralogy of Fallot compared to healthy controls?
Cross-Sectional (n=110)
No
Does three-dimensional speckle tracking echocardiography reveal impaired left ventricular mechanics in patients with repaired Tetralogy of Fallot compared to healthy controls?
Three-dimensional speckle tracking echocardiography demonstrates that patients with repaired Tetralogy of Fallot have impaired global and regional 3D systolic strain, mechanical dyssynchrony, and reduced twist, which correlates with reduced septal curvature.
Answers are grounded in this paper and cite their sources.
Detects subclinical LV impairment by 3D strain in repaired TOF; hypothesis-generating for outcomes and management until prospective data emerge.
BACKGROUND: Altered septal curvature and left ventricular (LV) geometry secondary to right ventricular (RV) dilation render two-dimensional assessment of LV mechanics difficult in repaired tetralogy of Fallot (TOF) patients. The novel three-dimensional (3D) speckle tracking echocardiography enables comprehensive evaluation of true 3D LV mechanics. METHODS AND RESULTS: Seventy-six patients aged 23.6 ± 8.3 years, 55 with isolated repair (group I) and 21 with subsequent pulmonary valve replacement (group II), and 34 healthy controls were studied. Three-dimensional volume datasets were acquired for assessment of LV global and regional 3D strain, systolic dyssynchrony index (SDI), twist, twist gradient (twist/LV length), and ejection fraction. A global performance index was calculated as (global 3D strain•twist gradient)/SDI. The septal curvature and LV eccentricity were determined from the mid-ventricular short-axis. Compared with controls, group I and II patients had significantly reduced LV global 3D strain, LV twist, twist gradient, septal curvature, and global performance index, and greater LV systolic and diastolic eccentricity and SDI (all p<0.05). All but the four apical LV segments in patients had reduced regional 3D strain compared with controls (all p<0.05). Septal curvature correlated with LV global 3D strain (r=0.41, p<0.001), average septal strain (r=0.38, p<0.001), twist (r=0.32, p<0.001), twist gradient (r=0.33, p<0.001), and global performance index (r=0.43, p<0.001). CONCLUSIONS: Adverse 3D LV mechanics as characterized by impaired global and regional 3D systolic strain, mechanical dyssynchrony, and reduced twist is related to reduced septal curvature in repaired TOF patients with and without pulmonary valve replacement.
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Li et al. (2013) conducted a cross-sectional in Repaired Tetralogy of Fallot (n=110). Repaired Tetralogy of Fallot (with or without PVR) vs. Healthy controls was evaluated on Left ventricular 3D global strain (%) (p=<0.001). Patients with repaired tetralogy of Fallot, both with and without pulmonary valve replacement, had significantly reduced left ventricular global 3D strain compared to healthy controls.
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