Current surgical procedures guarantee a survival at 20 years of repaired Tetralogy of Fallot (r-TOF) patients post pulmonary valve replacement (PVR) around 90%. The growing adult r-TOF population is not free from adverse events and right ventricular disfunction via ventricular-ventricular interactions might lead to left ventricular failure. To identify possible correlation between cardiac magnetic resonance (CMR) and speckle-tracking echocardiography (STE) functional data in r-TOF patients pre and post-PVR; to early depict systolic disfunction by global longitudinal strain (GLS) values and then optimize CMR and PVR timing; to identify correlation between GLS and feature tracking-CMR (FT-CMR) to detect differences in pre and post-PVR. Method: In this retrospective and partly prospective single center study, r-TOF patients’ inclusion criteria are: a) repaired TOF; b) available CMR and 2D-Echo data pre-PVR; c) underwent to PVR between July 2015 and September 2021; d) CMR and 2D-Echo data post-PVR. Multivariate analysis was performed. Results: Analysis performed on data obtained from the 15 eligible patients (8 females, mean age 23.4 years, SD 12.4 years) showed a statistically significant reduction in telediastolic (p.004) and telesystolic (p.01) volumes after PVR, with no significant increase in ejection fraction (p.853). Right ventricular ejection fraction pre- PVR was found to be an early indicator of right ventricular GLS post-PVR (p.027). Right ventricular GLS calculated by FT-CMR showed statistically significant improvement pre- and post- PVR (p.005). Conclusions: This study highlights that the sooner the valve replacement is performed, the better the GLS will be. Moreover, it depicts that right ventricular myocardial remodeling is well evaluated by STE and FT-CMR. Furthermore, it suggests an update of the current guidelines in order to include such parameters in the routinary evaluation of r-TOF patients post-PVR.
Role of speckle-tracking echocardiography and feature tracking-CMR in evaluation of myocardial deformation in repaired Tetralogy of Fallot patients.
Alice Pozza;Giovanni Di Salvo
2023
Abstract
Current surgical procedures guarantee a survival at 20 years of repaired Tetralogy of Fallot (r-TOF) patients post pulmonary valve replacement (PVR) around 90%. The growing adult r-TOF population is not free from adverse events and right ventricular disfunction via ventricular-ventricular interactions might lead to left ventricular failure. To identify possible correlation between cardiac magnetic resonance (CMR) and speckle-tracking echocardiography (STE) functional data in r-TOF patients pre and post-PVR; to early depict systolic disfunction by global longitudinal strain (GLS) values and then optimize CMR and PVR timing; to identify correlation between GLS and feature tracking-CMR (FT-CMR) to detect differences in pre and post-PVR. Method: In this retrospective and partly prospective single center study, r-TOF patients’ inclusion criteria are: a) repaired TOF; b) available CMR and 2D-Echo data pre-PVR; c) underwent to PVR between July 2015 and September 2021; d) CMR and 2D-Echo data post-PVR. Multivariate analysis was performed. Results: Analysis performed on data obtained from the 15 eligible patients (8 females, mean age 23.4 years, SD 12.4 years) showed a statistically significant reduction in telediastolic (p.004) and telesystolic (p.01) volumes after PVR, with no significant increase in ejection fraction (p.853). Right ventricular ejection fraction pre- PVR was found to be an early indicator of right ventricular GLS post-PVR (p.027). Right ventricular GLS calculated by FT-CMR showed statistically significant improvement pre- and post- PVR (p.005). Conclusions: This study highlights that the sooner the valve replacement is performed, the better the GLS will be. Moreover, it depicts that right ventricular myocardial remodeling is well evaluated by STE and FT-CMR. Furthermore, it suggests an update of the current guidelines in order to include such parameters in the routinary evaluation of r-TOF patients post-PVR.
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