Key result
Higher right ventricular wall stress was independently associated with lower right ventricular ejection fraction (decrease of 1.27% RVEF per kPa increase in wall stress, p=0.029).
Why the study?
Optimal timing of pulmonary valve replacement in repaired Tetralogy of Fallot patients remains challenging, and ventricular wall stress may serve as an early marker of right ventricular dysfunction.
Is right ventricular wall stress associated with right ventricular function in patients with repaired Tetralogy of Fallot?
Observational (n=10)
Is right ventricular wall stress associated with right ventricular function in patients with repaired Tetralogy of Fallot?
In repaired Tetralogy of Fallot patients, higher right ventricular wall stress is associated with lower right ventricular ejection fraction, suggesting its potential as an early marker of impending RV dysfunction.
RV wall stress may track functional changes in repaired TOF; leaves open role in PVR timing, needs prospective validation.
Background Optimal timing of pulmonary valve replacement (PVR) in Tetralogy of Fallot (TOF) patients remains challenging. Ventricular wall stress is considered to be an early marker of right ventricular (RV) dysfunction. Objectives To investigate the association of RV wall stresses and their change over time with functional parameters in TOF patients. Methods Ten TOF patients after surgical repair with moderate/severe pulmonary regurgitation were included. At two timepoints (median follow-up time 7.2 years), patient-specific computational biventricular models for wall stress assessment were created using CMR short-axis cine images and echocardiography-based RV pressures. RV ejection fraction (RVEF), NT-proBNP and cardiopulmonary exercise tests were used as outcome measures reflecting RV function. Associations between regional RV diastolic wall stress and RV function were investigated using linear mixed models. Results Increased wall stress correlated with lower RV mass ( r rm = −0.70, p = 0.017) and lower RV mass-to-volume ( r rm = −0.80, p = 0.003) using repeated measures. Wall stress decreased significantly over time, especially in patients with a stable RVEF ( p < 0.001). Higher wall stress was independently associated with lower RVEF, adjusted for left ventricular ejection fraction, RV end-diastolic volume and time since initial surgery (decrease of 1.27% RVEF per kPa increase in wall stress, p = 0.029) using repeated measurements. No association was found between wall stress, NT-proBNP, and exercise capacity. Conclusions Using a computational method to calculate wall stress locally in geometrically complex ventricles, we demonstrated that lower wall stress might be important to maintain ventricular function. RV wall stress assessment can be used in serial follow-up, and is potentially an early marker of impending RV dysfunction.
No takes yet. Share an insight, caveat, or question.
Minderhoud et al. (2023) conducted an observational in Tetralogy of Fallot (n=10). Right ventricular wall stress was evaluated on Right ventricular ejection fraction (RVEF) (decrease of 1.27% RVEF per kPa increase, p=0.029). Higher right ventricular wall stress was independently associated with lower right ventricular ejection fraction (decrease of 1.27% RVEF per kPa increase in wall stress, p=0.029).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: