Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study

Abstract

Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study ABSTRACTObjective: The present study aims to study the relationship between tissue Doppler echocardiography (TDE) indices of right ventricle and exercise capacity in patients after total correction for tetralogy of Fallot (ToF). Methods: This cross-sectional observational study included 20 patients, after undergoing total correction procedure for ToF diagnosed with mild/moderate pulmonary regurgitation and 30 age-matched healthy children. In the postoperative period, patients were invited to hospital for evaluation of the ventricular functions by 2D, M-mode, Doppler (DE) echocardiography and TDE and exercise testing to evaluate the effort capacity. Statistical analysis was performed using Mann-Whitney U and Chi-square tests, and Pearson correlation analysis. Results: Compared with the controls; the mitral annular peak systolic flow velocity (Sm) value was significantly lower, while isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT) and myocardial performance index (MPI) values obtained at the tricuspid and mitral (MV) valves were significantly higher (p<0.05 for all) in patients after ToF repair. There was a negative correlation between the exercise period and the total correction age (r=-0.20, p=0.015) and the same negative correlation existed between the exercise period and METS (r=-0.25, p=0.010). MV IVCT with DE and TDE was found to be correlated with METS (r=-0.45, p=0.04). Left ventricular MPI was found to be correlated with maximum heart rate (r=-0.20, p=0.03). By DE, tricuspid valve deceleration time and Sm peak flow velocity with TDE were significantly correlated with METS (r=-0.30, p=0.04; r=-025, p=0.005, respectively). MPI calculated with TDE was correlated with maximum heart rate (r=-0.15, p<0.01). Conclusion: Even if patients, undergone total correction surgery for ToF were asymptomatic or had minimal clinical symptoms, MPI index assessed by pulse wave TDE and exercise testing may allow early diagnosis of right ventricle dysfunction. Yöntemler: Enine kesitli-gözlemsel çalışmaya, Fallot Tetralojisi tanısı ile tam düzeltme operasyonu uygulanmış, hafif-orta derecede pulmoner regürjitasyonu olan 20 hasta ile kontrol grubu olarak 30 sağlıklı çocuk dahil edildi. Hastalar, ameliyat sonrası dönemde 2D, M mod, Doppler ekokardiyografi ve doku Doppler ekokardiyografi ile ventrikül fonksiyonları, egzersiz testi ile efor kapasiteleri değerlendirilmek üzere hastaneye çağrılmıştır. İstatistiksel analiz Mann-Whitney U ve Ki-kare testi ve Pearson korelasyon analizi ile yapıldı. Bulgular: Kontrol grubu ile karşılaştırıldığında, Fallot tetralojili hasta grubunda mitral annüler pik sistolik akım hız (Sm) değeri belirgin olarak düşük, triküspit ve mitral (MV) kapaktan elde edilen izovolümik relaksasyon zamanı (IVRT), izovolümik kontraksiyon zamanı (IVCT) ve miyokart performans indeksi (MPI) değerleri daha yüksek idi (tümü için p<0....

The Accuracy of Myocardial Performance Index in the Diagnosis of Right Ventricular Dysfunction After Surgical Correction of Tetralogy of Fallot: A Narrative Review

“…Saylan et al found no difference between the rTOF and normal groups in PD-RVMPI (0.13±0.03 and 0.15±0.04, P=0.16). However, TD-RVMPI was statistically higher in patients in respect of RV dysfunction after surgery (0.73±0.059 and 0.51±0.034, P<0.001) (27). PD-MPI was partially influenced by changes in preload and heart rate, while TD-MPI was not affected (15).…”

Outcomes of Tetralogy of Fallot repair performed after three years of age

“…Myocardial performance index values may allow early diagnosis of right ventricle diastolic dysfunction. 21 A limitation of this study was the small number of subjects. Patient databases in our institution contained incomplete addresses and phone numbers that we needed for follow-up evaluation after ToF repair.…”

“…There is no correlation between RVMPI and LVMPI, but these parameters can show us if there is any valve insufficiency after repair. 21,22 RVMPI 0.3 has a 10% sensitivity and 74% specificity to predict RVEF < 35%. 3 Similarly, we found that all subjects had abnormal MPI values, but there were no significant differences between the two groups.…”

“…Pre-operative hypoxia and hypertrophy, intra-operative myocardial injury, and pulmonary regurgitation after repair are the ethiopathogenesis of right ventricle dysfunction. 21 RBBB causes ventricular dyssynchrony, then ventricular dysfunction. 28 TAPSE, obtained in m-mode, reflects the base to apex shortening of the RV in systole.…”