Quantification of Right Ventricular Electromechanical Dyssynchrony in Relation to Right Ventricular Function and Clinical Outcomes in Children with Repaired Tetralogy of Fallot

Yim, Deane; Wang, Hui; Larios, Guillermo; Dragulescu, A.; Grosse-Wortmann, Lars; Bijnens, Bart; Mertens, Luc; Friedberg, Mark K.

doi:10.1016/j.echo.2018.03.012

Cited by 28 publications

(19 citation statements)

References 27 publications

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“…RV circumferential dyssynchrony was shown to negatively predict exercise capacity in one study 140 . This association has not been confirmed in other studies 138, 141 . Cardiac resynchronization therapy is increasingly used in ToF.…”

Section: Knowledge Gapscontrasting

confidence: 84%

“…Mechanical dyssynchrony has been demonstrated to relate to prolonged or fragmented (QRS complex containing additional spikes without bundle branch block) QRS complexes 137 . The contributions of this mechano-electrical interaction to RV function remain uncertain, as studies assessing mechanical dyssynchrony report conflicting results 135, 136, 138– 141 . RV circumferential dyssynchrony was shown to negatively predict exercise capacity in one study 140 .…”

Section: Knowledge Gapsmentioning

confidence: 99%

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Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.

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Section: Knowledge Gapscontrasting

confidence: 84%

Section: Knowledge Gapsmentioning

confidence: 99%

Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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“…24 Furthermore, higher RV mechanical dispersion values have been reported in TOF after surgical repair, reflecting electromechanical dyssynchrony severity and the underlying pathophysiology. 25 Our study and the previous ones concur in showing that surgical repair is followed by a more severe grade of electromechanical dyssynchrony, manifesting with higher RV strain and mechanical dispersion, and giving higher risk of VA. These finding is also in line with previous reports showing RV mechanical dispersion, possibly reflecting myocardial fibrosis as a marker of VA in patients with arrhythmogenic right ventricular cardiomyopathy.…”

Section: Pregnancy and Ventricular Arrhythmiasupporting

confidence: 90%

Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot

et al. 2021

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ObjectivePatients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women with TOF.MethodsWe recruited 80 women with repaired TOF from the national database. Holter monitoring or implanted devices detected VA, defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. All patients underwent echocardiography. Blood tests included NT-proBNP (N-terminal pro-brain natriuretic peptide).Results55 (69%) women had experienced pregnancy. Mean age was lower in nulliparous compared with those with children (30±9 vs 40±9, p<0.01).VA had occurred in 17 (21%) women. Prevalence of VA was higher in women who had experienced pregnancy (n=16, 94%) compared with nulliparous (n=1, 6%) (p=0.02), also when adjusted for age (OR 12.9 (95% CI 1.5 to 113.2), p=0.02).Right ventricular mechanical dispersion was more pronounced in patients with VA (50±8 ms vs 39±14 ms, p=0.01, age-adjusted OR 2.1 (95% CI 1.3 to 7.5), p=0.01). NT-proBNP was also a marker of VA (211 ng/L (127 to 836) vs 139 ng/L (30 to 465), p=0.007). NT-proBNP >321 ng/L (normal values <170 ng/L) detected women with VA (p=0.019), also independent of age (OR 7.2 (95% CI 1.7 to 30.1), p=0.007).ConclusionPregnancy was associated with higher prevalence of VA among women with TOF. Right ventricular mechanical dispersion and NT-proBNP were age-independent markers of VA. These may have importance for pregnancy counselling and risk stratification.

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“…Cardiac magnetic resonance (CMR) is considered a good method for the quantitative assessment of the severity of electromechanical dyssynchrony (Yim et al, 2018). However, unlike portable echocardiography, CMR is not flexible and convenient for field studies at HA.…”

Section: Rvd Measurements By Ste Analysismentioning

confidence: 99%

Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts

et al. 2020

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The aims of this study were to explore the effect of high-altitude (HA) exposure on the incidence, determinants, and impacts of right ventricular dyssynchrony (RVD). In our study, 108 healthy young men were enrolled, and physiological and echocardiographic variables were recorded at both sea level and 4,100 m. By using two-dimensional speckle-tracking echocardiography, RVD was evaluated by calculating the R-R intervalcorrected standard deviation of the time-to-peak systolic strain for the four mid-basal RV segments (RVSD4) and defined by RVSD4 > 18.7 ms. After HA exposure, RVSD4 was significantly increased, and the incidence of RVD was approximately 32.4%. Subjects with RVD showed lower oxygen saturation (SaO 2) and RV global longitudinal strain and higher systolic pulmonary artery pressure than those without RVD. Moreover, myocardial acceleration during isovolumic contraction was increased in all subjects and those without RVD, but not in those with RVD. Multivariate logistic regression revealed that SaO 2 is an independent determinant of RVD at HA (odds ratio: 0.72, 95% CI: 0.56-0.92; P = 0.009). However, the mean pulmonary artery pressure was linearly correlated with the magnitude of RVD in the presence of Notch. No changes were found in RV fractional area change, tricuspid annular motion, or tricuspid s' velocity between subjects with and without RVD. Collectively, we demonstrated for the first time that HA exposure could induce RVD in healthy subjects, which may be mainly attributed to the decline in SaO 2 as well as RV overload; the incidence of RVD was associated with reduced RV regional function and blunted myocardial acceleration.

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Quantification of Right Ventricular Electromechanical Dyssynchrony in Relation to Right Ventricular Function and Clinical Outcomes in Children with Repaired Tetralogy of Fallot

Cited by 28 publications

References 27 publications

Current outcomes and treatment of tetralogy of Fallot

Current outcomes and treatment of tetralogy of Fallot

Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot

Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts

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