Relation of right ventricular mechanics to exercise tolerance in children after tetralogy of Fallot repair

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

doi:10.1016/j.ahj.2012.06.029

Cited by 64 publications

(41 citation statements)

References 45 publications

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“…Thirteen published observational or case control studies met inclusion criteria (Figure 2). Three sets of articles used overlapping control population datasets (14 and 15, 19 and 20, 23 and 24). The first or last authors of each of these studies were contacted by electronic mail, and one control dataset was either provided or chosen based on author recommendation (Table 1 and Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

“…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). …”

Section: Resultsmentioning

confidence: 99%

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

Levy

Mejia

Machefsky

et al. 2014

Journal of the American Society of Echocardiography

144

108

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Background Establishment of the range of normal values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE) derived right ventricular (RV) strain is a prerequisite for its routine clinical application in children. The objectives of this study were to perform a meta-analysis of normal ranges of RV longitudinal strain measurements derived by 2DSTE in children and identify confounders that may contribute to differences in reported measures. Methods A systematic review was launched in PubMed, Embase, Scopus, Cochrane, and ClinicTrials.gov. Search hedges were created to cover the concepts of pediatrics, speckle-tracking echocardiography, and right heart ventricle. Two investigators independently identified and included studies if they reported the 2DSTE derived RV strain measures: RV peak global longitudinal strain (pGLS), systolic strain rate (pGLSRs), early diastolic strain rate (pGLSRe), late diastolic strain rate (pGLSRa), or segmental longitudinal strain at the apical, mid, and basal ventricular levels in healthy children. Quality and reporting of the studies were assessed. The weighted mean was estimated by using random-effects with 95% confidence intervals (CI), heterogeneity was assessed by the Cochran's Q statistic and the inconsistency index (I2), and publication bias was evaluated using funnel plots and the Egger test. Effects of demographic, clinical, equipment, and software variables were assessed in a meta-regression. Results The search identified 226 children from 10 studies. The reported normal mean values of pGLS among the studies varied from −20.80% to −34.10% (mean, −29.03%, 95%CI, −31.52% to −26.54%), pGLSRs varied from −1.30 to −2.40 1/sec (mean, −1.88, 95%CI, −2.10 to −1.59), pGLSRe ranged from 1.7 to 2.69 1/sec (mean, 2.34, 95%CI, 2.00 to 2.67) and pGLSRa ranged from 1.00 to 1.30 1/sec (mean, 1.18, 95% CI, 1.04 to 1.33). A significant base-to-apex segmental strain gradient (p <0.05) was observed in the right ventricular free wall. There was significant between-study heterogeneity and inconsistency (I2>88% and p<0.01 for each strain measure), which was not explained by age, gender, body surface area, heart rate, frame rate, tissue tracking methodology, equipment, or software. The meta-regression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (Egger test, p=0.59). Conclusions This study is the first to define normal values of two-dimensional speckle tracking echocardiographic (2DSTE) derived right ventricle strain in children on the basis of a meta-analysis. The normal mean value in children for RV global strain is −29.03% (95% CI, −31.52% to −26.54%). The normal mean value for RV global systolic strain rate is −1.88 1/sec (95% CI, −2.10 to −1.59). RV segmental strain has a stable base-to-apex gradient that highlights the dominance of deep longitudinal layers of the RV that are aligned base to apex. Variations among different normal ranges do not appe...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Levy

Mejia

Machefsky

et al. 2014

Journal of the American Society of Echocardiography

144

108

View full text Add to dashboard Cite

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“…In order to describe "improvement" in all patients, independently of the type of dominant lesion, we chose to use CPET parameters, considering the fact that impaired physical capacity is reported to be the one of the first signs of decline in RV function in asymptomatic patients [5]. The improvement was assessed using: (1) peak VO 2 -an important parameter defining the limits of the cardiopulmonary system [24]; (2) ventilatory response to exercise, defined as EQCO 2 (VE/VCO 2 ) at maximally obtained duration of exercise in both tests before and after PPVI.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is difficult to determine optimal timing for the intervention. Impaired physical capacity is reported to be the one of the first signs of decline in the RV function in asymptomatic patients [5,6]. The aim of this study was to investigate whether PPVI leads to an improvement in exercise function and which patients might benefit from the procedure when assessed with selected cardiopulmonary exercise testing (CPET) parameters.…”

Section: Introductionmentioning

confidence: 99%

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

et al. 2015

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Background: The aim of the study was to evaluate the role of cardiopulmonary exercise testing (CPET) parameters in assessing exercise capacity improvement after percutaneous pulmonary valve implantation (PPVI (25.3 ± 3.3 to 24.3 ± 3.0, p = 0.04) and oxygen consumption at peak exercise (pVO 2 ) (20.4 ± 5.0 to 22.6 ± 5.3 mL/ /kg/min, p = 0.04). Improved EQCO 2 correlated with an increase in right and left ventricular ejection fraction (respectively R = -0.57, p = 0.002; R = -0.56, p = 0.002). In this study, no baseline factors that might affect improvement in exercise function were found. Conclusions: Successful PPVI leads to an improvement in exercise capacity and hemodynamic response to exercise. The correlation between the improvement in EQCO 2 or peak VO 2 and baseline characteristics was too weak to reliably identify the group of patients that will benefit from the procedure. (Cardiol J 2015; 22, 3: 343-350) Key words: percutaneous pulmonary valve implantation, cardiopulmonary exercise testing, grown up congenital heart disease 343

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Systolic Ventricular Function

Mertens

Friedberg

2016

Echocardiography in Pediatric and Congenital Heart Disease

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Relation of right ventricular mechanics to exercise tolerance in children after tetralogy of Fallot repair

Cited by 64 publications

References 45 publications

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

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

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

Systolic Ventricular Function

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