Key result
Tetralogy of Fallot with pulmonary regurgitation was associated with reduced global area strain compared to healthy controls and ASD patients.
Why the study?
Right ventricular (RV) function assessment is crucial in congenital heart disease, but better characterization using both 3D RV shape and deformation in ASD and repaired TOF with PR was needed.
Does 3D echocardiographic strain and shape analysis differentiate right ventricular remodelling in ASD versus TOF-PR patients compared to healthy controls?
Case-Control (n=110)
Does 3D echocardiographic strain and shape analysis differentiate right ventricular remodelling in ASD versus TOF-PR patients compared to healthy controls?
Answers are grounded in this paper and cite their sources.
Chronic right ventricular volume loading causes similar shape remodelling in ASD and TOF patients, but RV strain is only reduced in TOF, suggesting fundamentally different remodelling processes.
AIMS: Right ventricular (RV) function assessment is crucial in congenital heart disease patients, especially in atrial septal defect (ASD) and repaired Tetralogy of Fallot (TOF) patients with pulmonary regurgitation (PR). In this study, we aimed to analyse both 3D RV shape and deformation to better characterize RV function in ASD and TOF-PR. METHODS AND RESULTS: We prospectively included 110 patients (≥16 years old) into this case-control study: 27 ASD patients, 28 with TOF, and 55 sex- and age-matched healthy controls. Endocardial tracking was performed on 3D transthoracic RV echocardiographic sequences and output RV meshes were post-processed to extract local curvature and deformation. Differences in shape and deformation patterns between subgroups were quantified both globally and locally. Curvature highlights differences in RV shape between controls and patients while ASD and TOF-PR patients are similar. Conversely, strain highlights differences between controls and TOF-PR patients while ASD and controls are similar [global area strain: -31.5 ± 5.8% (controls), -34.1 ± 7.9% (ASD), -24.8 ± 5.7% (TOF-PR), P < 0.001, similar significance for longitudinal and circumferential strains]. The regional and local analysis highlighted differences in particular in the RV free wall and the apical septum. CONCLUSION: Chronic RV volume loading results in similar RV shape remodelling in both ASD and TOF patients while strain analysis demonstrated that RV strain is only reduced in the TOF group. This suggests a fundamentally different RV remodelling process between both conditions.
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Moceri et al. (2020) conducted a case-control in Congenital heart disease (atrial septal defect and repaired Tetralogy of Fallot with pulmonary regurgitation) (n=110). Atrial septal defect and Tetralogy of Fallot with pulmonary regurgitation vs. Healthy controls was evaluated on Global area strain (p=< 0.001). Tetralogy of Fallot with pulmonary regurgitation was associated with reduced global area strain compared to healthy controls and ASD patients.
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