Role of Echocardiography for Assessment of Cardiac Remodeling in Congenitally Corrected Transposition of Great Arteries

Abstract

Background: The purpose of this study was to assess the role of echocardiography for a comprehensive assessment of cardiac remodeling, and the relationship between indices of cardiac remodeling and cardiovascular events (defined as the composite end point of heart failure hospitalization, heart transplant, or cardiovascular death) in adults with congenitally corrected transposition of great arteries (cc-TGA). Methods: This is a retrospective study of adults with cc-TGA who underwent echocardiogram (2003–2020). Offline image analysis was performed in all patients. Chamber (atrial and ventricular) function and size were assessed by strain imaging and 2-dimensional echocardiography. Results: Of 233 patients with cc-TGA (40±15 years), 123 (55%) had at least one cardiac procedure before baseline echocardiogram. Of 233 patients, 76% and 61% had left atrial dysfunction and systemic right ventricular dysfunction, respectively; while 43% and 11% had right atrial dysfunction and left ventricular dysfunction, respectively. During a median follow-up of 8.9 years, 114 (49%) underwent additional cardiac procedures, and 66 (28%) had cardiovascular events. Left atrial reservoir strain, right ventricular global longitudinal strain, right atrial reservoir strain, left ventricular systolic pressure, and left ventricular global longitudinal strain were independently associated with cardiovascular events. Conclusions: In addition to the clinical importance of right ventricular systolic dysfunction in cc-TGA that is already well described, the current study demonstrated, for the first time, that biatrial dysfunction was common and was associated with clinical outcomes. Since there are currently no effective therapies for atrial and ventricular dysfunction in patients with cc-TGA, there is a need for research to identify novel strategies to prevent atrial and ventricular dysfunction in this population.

Prognostic Value of the Anatomic-Physiologic Classification in Adults With Congenital Heart Disease

“…Most of the literature on risk stratification in adults with CHD was based on studies conducted in patients with specific CHD lesions, and these studies have identified risk factors such as systemic ventricular dysfunction, nonsystemic ventricular dysfunction, atrial fibrillation, impaired aerobic capacity, and prior heart failure hospitalization. 13,[22][23][24][25] Other studies that reported nonlesion risk 5.…”

“…Most of the literature on risk stratification in adults with CHD was based on studies conducted in patients with specific CHD lesions, and these studies have identified risk factors such as systemic ventricular dysfunction, nonsystemic ventricular dysfunction, atrial fibrillation, impaired aerobic capacity, and prior heart failure hospitalization. 13,22–25 Other studies that reported nonlesion risk scores such as the perioperative adult CHD score and the Aristotle score focused on perioperative risk assessment and hence not applicable for risk assessment in ambulatory patients. 26,27 The Seattle heart failure model is a well-validated risk model in patients with acquired heart disease, but its prognostic role in adults with CHD is not well understood.…”

“…Based on previous studies describing risk stratification in adults with CHD, 2,7,9–14 we considered the following variables as conventional clinical risk indices: (1) demographics (age and sex); (2) functional class (New York Heart Association classes I–IV); (3) prior cardiac procedures (the average number of cardiac surgeries, catheter interventions, and electrophysiologic procedures per patient); (4) comorbidities (hypertension, hyperlipidemia, type 2 diabetes, obesity, coronary artery disease, and atrial fibrillation); (5) end-organ function (estimated glomerular filtration rate and model for end-stage liver disease excluding international normalized ratio); and (6) echocardiographic indices ventricular and valvular function (systemic ventricular ejection fraction, nonsystemic ventricular fractional area change, systemic atrioventricular valve regurgitation, and nonsystemic atrioventricular valve regurgitation). Offline analysis of echocardiographic images was performed in all patients, and assessment of ventricular systolic function was performed using standard technique.…”

Cardiac Reverse Remodeling and Changes in Heart Failure Indices After Transcatheter Tricuspid Valve Replacement in Adults With Congenital Heart Disease

“…The procedural details for speckle tracking strain imaging for the assessment of RA, RV, LA, and LV function at this institution have been described. 15,16 RA and RV function were assessed using speckle tracking strain imaging obtained using Vivid E9 and E95 (General Electric Co, Fairfield, Connecticut) with M5S and M5Sc-D transducers (1.5-4.6 MHz) at frame rate of 40 to 80 Hz. Three-beat cine-loop clips were obtained from RV-focused apical four-chamber views.…”

Does Atrial Dysfunction Matter in Congenitally Corrected Transposition of Great Arteries?

“…In this issue, Egbe et al use a comprehensive echocardiographic protocol to study the impact of cardiac remodeling and chamber function on clinical outcomes. 5 The authors performed a baseline echocardiogram in adult ccTGA patients with a median age of 40 years and assessed clinical outcomes with a median follow-up time of around 9 years. It is a large single-center retrospective cohort study including 233 patients with 55% having simple ccTGA without other significant lesions.…”