Left Atrial Deformation Analysis in Patients with Corrected Tetralogy of Fallot by 3D Speckle-Tracking Echocardiography (from the MAGYAR-Path Study)

Abstract

BackgroundThree-dimensional (3D) echocardiography coupled with speckle-tracking echocardiographic (STE) capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA) volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF).ObjectivesTo compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls.MethodsThe study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years). They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men).ResultsIncreased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls.ConclusionsSignificant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair.

Left and Right Atrial Strain in Healthy Caucasian Children by Two-Dimensional Speckle-Tracking Echocardiography

“…Strain (ε) analysis has been applied for the analysis of ventricular function 1 and more recently for atrial function. [2][3][4][5][6][7][8][9] Left atrial (LA) ε has been proposed as a valuable marker in heart failure, 2 while the utility of right atrial (RA) ε has been reported in patients with pulmonary hypertension. 5 Studies of LA and RA ε in children with congenital or acquired heart disease are limited.…”

Háromdimenziós echokardiográfia alkalmazhatósága, értéke a veleszületett szívhibák diagnosztikájában

“…Megjelentek a rotációs és torzióra vonatkozó vizsgálatok gyerek és adoleszcens populá-cióban is, bár a klinikai gyakorlatba való átültetés még folyamatban van. Erre vonatkozóan hazai munkában előljárunk (13,14,15,16). Annyi tehát már megállapít-ható, hogy: 1. a 3DE-vel mért kamrai volumenek és EF-ek megbíz-hatóan ismételhetőek, 2. a 3DE-vel mért volumenek alacsonyabbak az MRIvel mértekkel, így a két vizsgálat adatai nem helyettesíthetőek, 3. a klinikai gyakorlatba a csecsemő és gyermekkori validált adatok hiányában még nem bevonhatóak.…”

Mitral annular dimensions and function in certain disorders and their relationship to left ventricular function

“…Due to the opportunity of early total reconstruction, there is an increasing number of patients with repaired TOF in the adult clinical practice (17). 3DSTEderived deformation analyses confirmed deteriorated left (18)(19)(20) and right (21)(22)(23) heart chambers including ventricles (18,19,21,23) and atria (20,22,23). Similarly to lipedema, morphological and functional assessment of the MA has never been performed in adult patients with repaired TOF.…”

“…According to recent findings from imaging studies, significant alterations could be detected in the left heart including LV and LA morphology and function in addition to right heart abnormalities in adults with repaired TOF (18)(19)(20)(21)(22)(23) of the type of correction. Moreover, patients who were treated with the two-step way (early palliation, late correction) showed worse results suggesting clinical benefits of early total reconstruction on late MA morphology and function.…”

“…Regarding to LV global longitudinal function in repaired TOF, global LV-LS was found to be reduced mainly due to the interventricular septum probably by mechanical coupling of the ventricles(18). In recent 3DSTE-derived atrial studies, both right atrial(RA) and LA volumes seemed to be increased in adult patients with repaired TOF with almost similar deformational abnormalities of RA and LA(20,22).Mitral valve and its annulus play an important role in regulating blood flow between LV and LA. According to the above mentioned alterations it could be theoretized, that MA could show significant remodelling in repaired TOF.…”