Left Ventricular Torsion and Strain in Patients with Repaired Tetralogy of Fallot Assessed by Speckle Tracking Imaging

Abstract

Background: In patients with tetralogy of Fallot (TOF), left ventricular (LV) dysfunction is an important factor associated with poor clinical outcome. Objective: The purpose of this study was to investigate the torsion and multidirectional strain of the LV in patients with TOF. Methods: Echocardiographic images were prospectively acquired in 29 patients who underwent TOF repair (age range, 5–25 years) and in 29 normal controls. Torsion and circumferential and longitudinal strain of the LV were assessed using speckle tracking imaging. Results: The torsion in patients was smaller compared to that in the controls due to small apical rotation and/or inverse basal rotation (P < 0.01). Torsion and untwisting rates decreased with increasing age (R = 0.37, P < 0.05). Basal circumferential strain and strain rate (SR) at systole and diastole decreased with age (R = 0.58; R = 0.57; R = 0.57, all P < 0.001) and were smaller in patients compared to those in the controls (all P < 0.01). Septal longitudinal strain and SR at systole and diastole decreased with age (R = 0.52; R = 0.62; R = 0.71, all P < 0.001) and were smaller than those of the controls (P < 0.01), although lateral longitudinal strain and SR were relatively maintained. Conclusion: Abnormal torsion and strain pattern of the LV were observed in patients without symptoms of cardiac failure. Assessment of torsion and strain is a very sensitive tool to detect the early deterioration of LV function in patients with TOF. (Echocardiography 2011;28:720‐729)

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

“…7,8,11-13,17,18,21,29-31,34,36-38,40,42,43,48 The normal mean values of systolic LSr varied from -0.41 to -2.59 (mean -1.20, 95% CI -0.96 to -1.44). The normal mean values of early diastolic LSr varied from 1.60 to 3.15 (mean 2.23, 95% CI 1.89 to 2.53), and the normal mean values of late diastolic LSr for varied from 0.40 to 2.41 (mean 0.80, 95% CI 0.64 to 0.95).…”

“…LV free wall from the apical 4- chamber views was reported in 9 of 43 data sets ( n=716 children). 7,8,16,17,28-30,34,36 The normal mean values of FW SL varied from -17.00% to -23.4 % (mean -20.2%, 95% CI -19.2% to -22.2%). Between-study heterogeneity was evidenced by a Cochran's Q statistic of 458 (P < 0.0001) and inconsistency by an I 2 value of 96.3%.…”

“…14,15,20,23,24,28,30,39 Nine of the 44 datasets ( n=716 children) reported LV SLS from the apical 4-chamber view only (9 out of 26 that reported LS from the apical 4-chamber view only). 7,8,16,17,28-30,34,36 The meta-analysis demonstrated a significant (P < 0.001) apex-to-base (highest-to-lowest) gradient for the mean values of normal LV SLS from the three apical views (-19.9% -19.2%, -18.7%), respectively and from the apical 4-chamber alone (-20.6%, -19.9%, -19.5%, respectively). Between-study heterogeneity was evidenced by a Cochran's Q statistic ranging from 312 to 555 (P < 0.001) and inconsistency by an I 2 value ranging from 97.2% to 98.9%.…”

“…Takayasu et al generated strain measures in two separate cohorts of children and adolescents. 17 The breakdown of the age distribution for the remaining 38 datasets was: four data-sets recruited patients 0-1 years of age, 30,36,37,47 18 datasets had patients with age ranges of 2 and 9 years of age, 7,10,12,13,15,18,22,26,29,31,34,35,39,40,42,43,48 10 datasets had patients with age ranges of 10 and 13 years of age, 9,14,19-21,25,27,32,41,46 6 datasets examined patients with age ranges 14-21 years of age. 11,23,24,28,38,44 We performed a separate meta analysis for LV strain measures stratified by age distribution using the mean age from each study as a continuous variable and also by categorizing each study into one of the four age distribution categories, 0-1, 2-9, 10-13, and 14-21 (Figures 2-4).…”

Right Ventricular Remodeling Due to Pulmonary Regurgitation Is Associated With Reduced Left Ventricular Free Wall Strain in Surgically Repaired Tetralogy of Fallot

“…26 As for RV, the RV free wall as well as the septal wall were impaired in the r-TOF subjects. 27 RV remodeling due to PR, the patch used in the radical operation, and abnormal muscle fiber architecture could affect RV strain in the subjects with r-TOF. 26 Additionally, impairment of LV free wall LS might be induced by hypoxemia.…”