Key result
Patients with a systemic right ventricle had significantly reduced right ventricular atrioventricular plane displacement compared to healthy controls (mean difference -8.05 mm, p<0.001), reflecting abnormal myocardial deformation due to increased afterload.
Why the study?
Does increased afterload affect right ventricular myocardial deformation and exercise capacity in adult patients with congenital heart disease?
Cross-Sectional (n=51)
No
Does increased afterload affect right ventricular myocardial deformation and exercise capacity in adult patients with congenital heart disease?
Mean Difference: -8.05 (95% CI -9.59–-6.5)
Absolute Event Rate: 8% vs 16%
p-value: p=<0.001
Adult patients with congenital heart disease exhibit abnormal right ventricular myocardial deformation, with increased afterload significantly impairing right ventricular global longitudinal strain and atrioventricular plane displacement.
May inform monitoring in systemic right ventricle; leaves open prognostic value pending prospective validation.
BACKGROUND: Prior studies suggested that myocardial deformation is superior to conventional measures for assessing ventricular function. This study aimed to evaluate right ventricular (RV) myocardial deformation in response to increased afterload. Patients with the RV in the systemic position were compared with patients with the RV in the sub-pulmonic position with normal or only slightly elevated systolic right ventricular pressure. Correlations between global longitudinal strain (GLS), radial strain, atrioventricular plane displacement (AVPD), and exercise capacity were evaluated. METHODS: 44 patients with congenital heart defect were enrolled in the study. The control group consisted of seven healthy volunteers. All patients underwent cardiovascular magnetic resonance (CMR) and cardiopulmonary exercise testing. We assessed biventricular myocardial function using CMR based feature tracking and compared the results to anatomic volumes. RESULTS: Strain analysis and displacement measurements were feasible in all participants. RVGLS and RVAVPD were reduced in both study groups compared to the control group (p<0.001). Left ventricular (LV) radial strain was significantly lower in patients with a systemic RV than in those with a subpulmonic RV and lower than in controls (p<0.001). Both LVAVPD and RVAVPD were significantly depressed in patients compared to controls (p<0.05). RVAVPD was more depressed in patients with a high systolic RV pressure than in those with normal RV pressure (p<0.001). RVAVPD did not correlate with exercise capacity in either study group. Exercise capacity in both patient groups was depressed to levels reported in previous studies, and did not correlate with RVGLS. CONCLUSIONS: Both study groups had abnormal myocardial deformation and increased RV volumes. RVGLS in patients was lower than in controls, confirming the effect of increased afterload on myocardial performance.
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Trzebiatowska‐Krzynska et al. (2018) conducted a cross-sectional in Congenital Heart Disease (Tetralogy of Fallot and Transposition of the Great Arteries) (n=51). Systemic right ventricle (TGA) vs. Healthy controls was evaluated on Right ventricular atrioventricular plane displacement (RVAVPD) (MD -8.05 mm, 95% CI -9.59 to -6.50, p=<0.001). Patients with a systemic right ventricle had significantly reduced right ventricular atrioventricular plane displacement compared to healthy controls (mean difference -8.05 mm, p<0.001), reflecting abnormal myocardial deformation due to increased afterload.
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