Evaluation of right ventricular global longitudinal function in patients with tetralogy of fallot by two-dimensional ultrasound speckle tracking imaging

Abstract

Quantification of right ventricular (RV) volume and function remains a challenge because of RV complex geometry by conventional echocardiography. The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot (TOF) by 2-dimensional ultrasound speckle tracking imaging (STI). Thirty-eight patients with TOF were enrolled in this study and divided into child group (n=25) and adult group (n=13) according to age. Thirty-eight age- and sex-matched normal subjects were selected as control groups including child control group (n=25) and adult control group (n=13). RV global longitudinal peak systolic strain (GLS), strain rate (GLSR(s)), early diastolic strain rate (GLSR(e)) and late diastolic strain rate (GLSR(a)) were measured in all subjects by STI from the apical 4-chamber view and compared between groups. Furthermore, the main factors affecting the RV global longitudinal functional parameters were assessed. Compared with those in controls, RV GLS, GLSR(s) and GLSR(e) were significantly reduced in patients with TOF (P<0.05 for all). RV GLSR(s) was significantly decreased in adult patients with TOF as compared with that in child patients (P<0.05). There was no significant difference in RV GLS, GLSR(e) and GLSR(a) between child and adult TOF groups (P>0.05). The diameter of right ventricle, main pulmonary artery and ventricular septum defect had correlations with RV GLSR(s) (r ( 1 )=-0.490, r ( 2 )=0.580, r ( 3 )=-0.528, respectively, P<0.05 for all). Tricuspid annular plane peak systolic velocity (Sm) was the independent predictor of RV global strain and strain rate (beta(1)=0.355, P (1)=0.031, beta(2)=0.307, P (2)=0.021). RV global longitudinal function is decreased in patients with TOF, especially in adult patients. STI is a sensitive and accurate technique in RV global functional assessment.

Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation

“…9-11 We have reported similar findings in the current cohort. 12 However, the clinical utility of detecting these changes by STE is unknown in this population.…”

Normal Ranges of Right Ventricular Systolic and Diastolic Strain Measures in Children: A Systematic Review and Meta-Analysis

“…Previous individual studies have demonstrated a base-to-apex segmental longitudinal strain gradient for the RV in children and adults (13,18–20,23,24) and this base-to-apex gradient is reflective in the segmental longitudinal strain meta-analysis (Figure 5). This pattern remains relatively unchanged and may reflect the relative constant geometry of normal heart with maturation.…”

“…From the 10 datasets, 6 datasets with 136 patients reported pGLSRs and were included in the meta-analysis of pGLSRs (13–15,17–20,22), 5 datasets with 116 patients were eligible for the meta-analysis of pGLSRe (14–15,17–20,22), and 4 datasets with 67 patients were eligible for the meta-analysis of pGLSRa (17–20,22). In addition, from the 10 datasets, 5 datasets with 100 patients reported segmental strain measures at the apex, mid and basal ventricular levels of the RVFW, and were analyzed in the meta-analysis of segmental strain (13,16,18–20,23,24). The patient characteristics of the included studies are listed in Table 1.…”

“…None of the studies clearly stated how many echo-sonographers acquired the images and their training level with regard to 2DSTE image acquisition. There were only a few studies that specified how many individuals performed the data analysis and if they were blinded to the patient outcomes (12,18–20). Intra- and inter- observer reproducibility analysis was performed in 6/10 datasets, (12–15,18–21) and referenced in 3/10 (17,22–24).…”

“…Five out of the ten eligible datasets in this meta-analysis reported segmental RV strain at all three levels of the right ventricular free wall (13,16,18–20,23,24). Of theses, 3 datasets used the Full RV Myocardium method (16,18–20), and 2 datasets employed the RVFW only method (13,23,24) to generate RV segmental longitudinal strain. The meta-analysis demonstrated a significant (P < 0.05) base-to-apex gradient for the mean values of normal RV segmental strain (−33.53, −32.33, −29.16, respectively) (Figure 5).…”