Key result
Post-Senning children show worse resting RVGLS than controls but improve during dobutamine stress.
Why the study?
Quantitative assessment of systemic RV contractile reserve in post-Senning children is mandatory to anticipate the need for anti-failure treatment but remains inadequately evaluated.
Does speckle-tracking global longitudinal strain during dobutamine stress echocardiography improve the detection of masked contractile reserve in post-Senning children compared to standard RVEF?
Observational (n=61)
Does speckle-tracking global longitudinal strain during dobutamine stress echocardiography improve the detection of masked contractile reserve in post-Senning children compared to standard RVEF?
Absolute Event Rate: -11.89% vs -22.35%
p-value: p=<0.001
Speckle-tracking global longitudinal strain during dobutamine stress echocardiography is superior to standard ejection fraction for detecting masked contractile reserve in the systemic right ventricle of post-Senning children.
Impaired resting RV strain in post-Senning children may warrant surveillance; leaves open the prognostic value of dobutamine stress response.
Introduction: The systemic load on the right ventricle (RV) after Senning atrial switch leads to ventricular dysfunction. Quantitative assessment of RV contractile reserve is mandatory to anticipate the need for anti-failure treatment. We aimed to quantitatively assess RV contractile reserve in Senning children by interrogating speckled global longitudinal strain (GLS) during dobutamine stress echocardiography (DSE). Methods: This prospective study compared thirty-one post-Senning children (group I), and thirty controls (group II). In post-Senning children, echocardiographic RV systolic function using automated Simpson’s one-plane ejection fraction (RVEF), tricuspid annulus plane systolic excursion (TAPSE), and RVGLS were recorded at rest and at peak DSE. The contractile reserve was defined as improvement >5% in RVEF, >2% in GLS, and/or to near normal values in TAPSE. Results: RVEF, and TAPSE were significantly lower in patients than controls (RVEF: 40.13±2.93% vs. 53.17±3.17% respectively, P<0.001*, TAPSE: 13.81±1.26 vs. 17.45±2.93 mm respectively, P<0.001*). Also, RVGLS was significantly worse in Senning children than controls (-11.89±2.31% vs. -22.35±6.73% respectively, P<0.001*). At peak DSE, contractile reserve was not evident as measured by RVEF which increased none significantly to 42.47±2.80% (P=0.063). However, RVGLS improved significantly to -15.78±0.93% (P<0.001*) and discovered the masked contractile reserve in Senning children. The 19(61.29%) children who showed masked contractile reserve (improvement in RVGLS>2%) underwent continuation of anti-failure medications. Conclusions: Despite systemic RV function in post-Senning children was impaired at rest and during DSE, RVGLS was useful in quantitative assessment of masked contractile reserve that was not evaluated by the ordinary RVEF, thus promoted continuing anti-failure treatment.
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F. Taha (2020) conducted an observational in Systemic right ventricle dysfunction post-Senning atrial switch (n=61). Post-Senning atrial switch vs. Healthy controls was evaluated on Right ventricular global longitudinal strain (RVGLS) at rest (p=<0.001). Post-Senning children had significantly worse resting right ventricular global longitudinal strain compared to controls (-11.89% vs. -22.35%, P<0.001), which improved during dobutamine stress.
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