Myocardial Deformation in the Systemic Right Ventricle: Strain Imaging Improves Prediction of the Failing Heart

Woudstra, Odilia I.; Dissel, Alexandra C. van; Bom, Teun van der; Bruin‐Bon, Rianne H.A.C.M. de; Melle, Joost P. van; Dijk, Arie P.J. van; Vliegen, Hubert W.; Mulder, Barbara J.M.; Tanck, Michael W.T.; Meijboom, Folkert J.; Bouma, Berto J.

doi:10.1016/j.cjca.2019.12.014

Cited by 9 publications

(5 citation statements)

References 39 publications

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“…RV GLS improvement may have relevant prognostic implications, as it has been proven to predict survival free from events in patients with a sRV. 20 In addition, our results provide the first evidence of sRV reverse remodeling, as demonstrated by reduction of RV volumes and TR severity. The magnitude of sRV reverse remodeling was similar in TGA and ccTGA patients, despite different physiopathology, which also comprises the contribution of diastolic dysfunction due to stiff venous return baffle in atrial switch repair for TGA.…”

Section: Discussionsupporting

confidence: 57%

Safety and Efficacy of Sacubitril/Valsartan in Patients With a Failing Systemic Right Ventricle: A Prospective Single-Center Study

Fusco

Scognamiglio

Merola

et al. 2023

Circ: Heart Failure

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BACKGROUND: Sacubitril/valsartan was demonstrated to reduce hospitalization rate and mortality in patients with heart failure with reduced ejection fraction. Data on the effects of sacubitril/valsartan in patients with a systemic right ventricle are still lacking. METHODS: Patients with transposition of the great arteries following Senning/Mustard procedure or congenitally corrected transposition of the great arteries with impaired systemic right ventricle systolic function were prospectively included. Primary end points included sacubitril/valsartan safety and efficacy. Primary efficacy end points were NT-proBNP (N-terminal pro-B-type natriuretic peptide) and systolic function improvement. Secondary end points included New York Heart Association class, 6-minute walking distance, and quality of life change. RESULTS: Fifty patients (38±12 years, 60% male, 35% congenitally corrected transposition of the great arteries) were included and followed for 1 year. No major adverse events occurred. Two (4%) patients ceased treatment due to hypotension and 1 (2%) developed a nephrotic syndrome. The target dose was reached in 20 (42%) patients. NT-proBNP values decreased significantly immediately after treatment initiation, while returned to baseline at 1 year. Echocardiography showed progressive fractional area change increase (29.2±5.8 versus 34.9±5.1%; P <0.001), and right ventricle global longitudinal strain (−13.9 [−15.1, −11.8] versus −15.3 [−17.2, −13.4]%; P <0.001) and free-wall global longitudinal strain (−14.3 [−17.3, −12.3] versus −17.2 [−19.3, −15.8]%; P <0.001) raise, whereas tricuspid regurgitation severity improved only in transposition of the great arteries patients ( P =0.006). Moreover, 3-dimensional echocardiography demonstrated right ventricle volumes reduction (end-diastolic volume: 181±63 versus 156±50 mL; P =0.002; end-systolic volume: 117±48 versus 89±33 mL; P <0.001), and significantly increased systemic right ventricle ejection fraction (35.6±8.1 versus 41.5±7.5%; P <0.001). Clinical improvement was suggested by New York Heart Association class change ( P <0.001), increased 6-minute walking distance (425 [333, 480] versus 500 [443, 560] m; P <0.001) as well as improved quality of life at 1-year follow-up. Beneficial effects were observed irrespective of the underlying anatomy and were more pronounced in those on target dose. CONCLUSIONS: Our data showed that sacubitril/valsartan is well tolerated and is associated with systemic right ventricle remodeling and improved systolic function as well as improved clinical status, supporting its use in this complex population.

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Section: Discussionsupporting

confidence: 57%

Safety and Efficacy of Sacubitril/Valsartan in Patients With a Failing Systemic Right Ventricle: A Prospective Single-Center Study

Fusco

Scognamiglio

Merola

et al. 2023

Circ: Heart Failure

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“…Unfortunately, despite this good reproducibility, the association between RV free wall global longitudinal 2D strain (using the RV software algorithm) and peak VO2 in our study did not reach statistical significance (r ¼ 0.23; P ¼ 0.14), probably because of a low sample size. Indeed, previous studies found a significant association, in patients with systemic RV, between RV free wall global longitudinal 2D strain and peak VO2 (r ¼ 0.42; P ¼ 0.007) [21], clinical events [37] or RV ejection fraction [38,39].…”

Section: Discussionmentioning

confidence: 91%

Reliability of echocardiographic parameters of the systemic right ventricle systolic function: A prospective multicentre study

Pommier

Bredy

Abassi

et al. 2021

Archives of Cardiovascular Diseases Supplements

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Background: Systemic right ventricle (RV) is a rare and complex form of congenital heart disease (CHD) with a prognosis related to RV dysfunction and impaired physical capacity. Routine follow-up relies on echocardiography, however the prognostic value of echocardiography parameters remains under debate. Real-life patient follow-up involves different ultrasound systems. We aimed to evaluate echocardiography parameters' reliability in systemic RV, in terms of reproducibility, using vendor-independent software, and in terms prediction of physical capacity impairment. Methods: Adult patients with D-transposition of the great artery (d-TGA) who underwent atrial switch or with congenitally corrected TGA (cc-TGA) were included in this multicentre prospective study. Current echocardiography parameters were analysed using TomTec-Arena™ software. Intraclass correlation coefficients (ICC) assessed inter-and intraobserver reliability. Associations between the most reproducible echocardiography parameters and exercise capacity (peak VO2, VE/VCO2 slope) were explored. Results: A total of 47 patients were included in the study (87% d-TGA, median age 36.4 AE 8 years). Conventional and 2D strain echocardiography parameters indicated the existence of a RV dysfunction (TAPSE ¼ 12.8 AE 3.1 mm; RV free wall longitudinal 2D strain ¼ -13.6 AE 3.9%). Good reproducibility (ICC>0.75) for both intra and interobserver variability was observed in 8 RV echocardiography parameters. Only the TAPSE was significantly associated with peak VO2 (r ¼ 0.4, P ¼ 0.02). Conclusions: In this prospective study mimicking real-life echocardiography follow-up of systemic RV, TAPSE, RV free wall longitudinal 2D strain and peak systolic S wave, were the most reproducible echocardiography parameters. However, only the TAPSE was associated with peak VO2.

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“…showed in 60 patients with a systemic right ventricle in the context of ccTGA ( n = 21) or after an atrial switch operation for TGA ( n = 39) that, besides 3‐dimensional CMR / computed tomographic derived ejection fraction, only echocardiographic assessed GLS of the systemic right ventricle was independently associated with heart failure during a median follow‐up of 8 (IQR: 7–9) years (Table 1). 11 …”

Section: Resultsmentioning

confidence: 99%

“…10 This parameter was also studied in a retrospective analysis of the VALsartan in SystEmic Right VEntricle (VAL-SERVE) trial: Woudstra et al showed in 60 patients with a systemic right ventricle in the context of ccTGA (n = 21) or after an atrial switch operation for TGA (n = 39) that, besides 3-dimensional CMR / computed tomographic derived ejection fraction, only echocardiographic assessed GLS of the systemic right ventricle was independently associated with heart failure during a median follow-up of 8 (IQR: 7-9) years (Table 1). 11 One recent study (n = 151) investigated the role of LV and RV strain in TGA patients who were operated with an arterial switch or Rastelli operation in whom the LV is connected to the systemic circulation. In these patients, the peak strain values of the RV septum and free wall were independently related to atrial arrythmia induced heart failure hospitalization (n = 9) (Table 1).…”

Section: Transposition Of the Great Arteriesmentioning

confidence: 99%

Prognostic significance of echocardiographic deformation imaging in adult congenital heart disease

van Rosendael,

Taha,

Guglielmo

et al. 2024

Eur J Clin Investigation

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BackgroundDue to medical and surgical advancements, the population of adult patients with congenital heart disease (ACHD) is growing. Despite successful therapy, ACHD patients face structural sequalae, placing them at increased risk for heart failure and arrhythmias. Left and right ventricular function are important predictors for adverse clinical outcomes. In acquired heart disease it has been shown that echocardiographic deformation imaging is of superior prognostic value as compared to conventional parameters as ejection fraction. However, in adult congenital heart disease, the clinical significance of deformation imaging has not been systematically assessed and remains unclear.MethodsAccording to the Preferred Reporting Items for Systematic Reviews checklist, this systematic review included studies that reported on the prognostic value of echocardiographic left and/or right ventricular strain by 2‐dimensional speckle tracking for hard clinical end‐points (death, heart failure hospitalization, arrhythmias) in the most frequent forms of adult congenital heart disease.ResultsIn total, 19 contemporary studies were included. Current data shows that left ventricular and right ventricular global longitudinal strain (GLS) predict heart failure, transplantation, ventricular arrhythmias and mortality in patients with Ebstein's disease and tetralogy of Fallot, and that GLS of the systemic right ventricle predicts heart failure and mortality in patients post atrial switch operation or with a congenitally corrected transposition of the great arteries.ConclusionsDeformation imaging can potentially impact the clinical decision making in ACHD patients. Further studies are needed to establish disease‐specific reference strain values and ranges of impaired strain that would indicate the need for medical or structural intervention.

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Myocardial Deformation in the Systemic Right Ventricle: Strain Imaging Improves Prediction of the Failing Heart

Cited by 9 publications

References 39 publications

Safety and Efficacy of Sacubitril/Valsartan in Patients With a Failing Systemic Right Ventricle: A Prospective Single-Center Study

Safety and Efficacy of Sacubitril/Valsartan in Patients With a Failing Systemic Right Ventricle: A Prospective Single-Center Study

Reliability of echocardiographic parameters of the systemic right ventricle systolic function: A prospective multicentre study

Prognostic significance of echocardiographic deformation imaging in adult congenital heart disease

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