Impaired Left Ventricular Myocardial Mechanics and Their Relation to Pulmonary Regurgitation, Right Ventricular Enlargement and Exercise Capacity in Asymptomatic Children after Repair of Tetralogy of Fallot

Fernandes, Fernanda Pimenta; Manlhiot, Cedric; Roche, S. Lucy; Grosse-Wortmann, Lars; Slorach, Cameron; McCrindle, Brian W.; Mertens, Luc; Kantor, Paul F.; Friedberg, Mark K.

doi:10.1016/j.echo.2012.01.014

Cited by 68 publications

(56 citation statements)

References 36 publications

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“…All the studies used a deformation imaging acquisition and post-processing protocol. Reproducibility analysis was performed in 32/43 7-10,14-21,23-27,33,35-46,48,49 datasets and referenced in 4/43. 11,30,31,47 …”

Section: Resultsmentioning

confidence: 99%

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Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

257

215

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Background The establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE) derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims were to perform a meta-analysis of normal ranges of LV global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS) measurements derived by 2DSTE in children and identify confounding factors that may contribute to variances in reported measures. Methods A systematic review was launched in Medline, Embase, Scopus, CINAHL, and Cochrane. Search hedges were created to cover the concepts of pediatrics, speckle-tracking echocardiography, and left heart ventricle. Two investigators independently identified and included studies if they reported the 2DSTE derived LV GLS, GCS or GRS. The weighted mean was estimated by using random-effects with 95% confidence interval (CI), heterogeneity was assessed by the Cochran's Q statistic and the inconsistency index (I2) and publication was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a meta-regression. Results The search identified 2325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean -20.2%, 95% CI -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean -22.3%, 95% CI -19.9% to -24.6%) and GRS, varied from 33.9% to 54.5 % (mean 45.2 95% CI 38.3 to 51.7). 26 studies reported LS only from the apical 4-chamber view with a mean of -20.4%, (95% CI -19.8% to -21.7%). 23 studies reported CS (mean, -20.3%, 95% CI -19.4% to -21.2%) and RS (mean, 46.7%, 95% CI 42.3% to 51.1%) from the short axis view at the mid-ventricular level. A significant apex-to-base segmental longitudinal strain (SLS) gradient (P < .01) was observed in the LV free wall. There was significant between- study heterogeneity and inconsistency (I2 > 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, FR/HR ratio tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. These metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). Conclusions This study defined reference values of 2DSTE derived LV strain in children on the basis of a meta-analysis. In healthy children, the mean LV global longitudinal strain value is -20.2%, (95% CI -19.5% to -20.8%), mean global circumferential strain -22.3%, (95% CI -19.9% to -24.6%), and mean global radial strain is 45.2%, (95% CI 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturations. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor para...

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Section: Resultsmentioning

confidence: 99%

“…7,8,10-13,16-19,21,22,28-34,36-38,40,42,43,48 (There were four datasets that reported both the GLS and the LS from the apical 4-chamber view only. 19,28,30,33 ) The normal mean values of LS varied from -15.1% to -24.8% (mean -20.4, 95% CI -19.8% to -21.7%), (Figure 2b).…”

Section: Resultsmentioning

confidence: 99%

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

257

215

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“…Though this requires further study, LV strain could be an earlier marker of LV dysfunction in this setting, consistent with literature in PH and other conditions. 8, 9, 21, 22 …”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Myocardial Function in Children With Pulmonary Hypertension

Burkett

Slorach

Patel

et al. 2015

Circ: Cardiovascular Imaging

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Background Through ventricular interdependence, pulmonary hypertension (PH) induces left ventricular (LV) dysfunction. We hypothesized that LV strain/strain rate, surrogate measures of myocardial contractility, are reduced in pediatric PH and relate to invasive hemodynamics, right ventricular (RV) strain, and functional measures of PH. Methods and Results At two institutions, echocardiography was prospectively performed in 54 pediatric PH patients during cardiac catheterization, and in 54 matched controls. PH patients had reduced LV global longitudinal strain (LS) (-18.8 [-17.3 - -20.4]% vs. -20.2 [-19.0 - -20.9]%, P=0.0046) predominantly due to reduced basal (-12.9 [-10.8 - -16.3]% vs. -17.9 [-14.5 - -20.7]%, P<0.0001) and mid (-17.5 [-15.5 - -19.0]% vs. -21.1 [-19.1 - -23.0]%, P<0.0001) septal strain. Basal global circumferential strain (CS) was reduced (-18.7 [-15.7 - -22.1]% vs. -20.6 [-19.0 - -22.5]%, P=0.0098), as were septal and free-wall segments. Mid CS was reduced within the free-wall. Strain rates were reduced in similar patterns. “Basal septum” LS, the combined average LS of basal and mid interventricular septal segments, correlated strongly with degree of PH (r=0.66, P<0.0001), pulmonary vascular resistance (r=0.60, P<0.0001), and RV free-wall LS (r=0.64, P<0.0001). Brain natriuretic peptide levels correlated moderately with septal LS (r=0.48, P=0.0038). PH functional class correlated moderately with LV free-wall LS (r=-0.48, P=0.0051). The septum, shared between ventricles and affected by septal shift, was the most affected LV region in PH. Conclusions Pediatric PH patients demonstrate reduced LV strain/strain rate, predominantly within the septum, with relationships to invasive hemodynamics, RV strain, and functional PH measures.

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“…Despite the importance of LV dysfunction, the mechanisms and time course of the development of LV dysfunction remain poorly understood. 14 Its mechanisms and time course in patients with rTOF are important because it has the potential to become T etralogy of Fallot (TOF) is the most prevalent form of cyanotic congenital heart disease. 1 Significant advances in the early management of TOF have dramatically improved the survival of TOF patients, 2 with current 30-year survival rates reaching 89%.…”

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confidence: 99%

Mechanisms of Left Ventricular Dysfunction Assessed by Layer-Specific Strain Analysis in Patients With Repaired Tetralogy of Fallot

Yamada

Takahashi

Kobayashi

et al. 2017

Circ J

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importance of LV-RV interaction in patients who have undergone TOF repair. 8 Geva et al showed that lower LVEF and older age at repair were the strongest independent factors associated with impaired clinical status in long-term survivors of rTOF. 13 Recently, Diller et al showed that LV longitudinal dysfunction, such as impairment in longitudinal global strain and decreased mitral annular plane systolic excursion, were associated with an increased risk of sudden cardiac death and/or life threatening ventricular arrhythmias in patients with rTOF. 12 Therefore, the assessment of LV function in patients with TOF is crucial because it is the strongest determinant of a poor clinical outcome in these patients. Despite the importance of LV dysfunction, the mechanisms and time course of the development of LV dysfunction remain poorly understood. 14 Its mechanisms and time course in patients with rTOF are important because it has the potential to become T etralogy of Fallot (TOF) is the most prevalent form of cyanotic congenital heart disease. 1 Significant advances in the early management of TOF have dramatically improved the survival of TOF patients, 2 with current 30-year survival rates reaching 89%. 3 However, late ventricular dysfunction related to residual hemodynamic and electrophysiological abnormalities remains a problem, contributing to increasing morbidity and mortality rates beginning in the third decade of life. 2,4-6 Previous investigators assessing ventricular function in patients with repaired TOF (rTOF) have primarily focused on right ventricular (RV) mechanics and their interaction with pulmonary regurgitation (PR). 7-9 Moreover, the importance of left ventricular (LV) dysfunction as a risk factor for long-term adverse outcomes is increasingly acknowledged. (rTOF) is an important risk factor for adverse outcomes. The aim of this study was to assess the details and time course of such LV dysfunction using layer-specific strain analysis by echocardiography.

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Impaired Left Ventricular Myocardial Mechanics and Their Relation to Pulmonary Regurgitation, Right Ventricular Enlargement and Exercise Capacity in Asymptomatic Children after Repair of Tetralogy of Fallot

Cited by 68 publications

References 36 publications

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Left Ventricular Myocardial Function in Children With Pulmonary Hypertension

Mechanisms of Left Ventricular Dysfunction Assessed by Layer-Specific Strain Analysis in Patients With Repaired Tetralogy of Fallot

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