Relationship between temporal sequence of right ventricular deformation and right ventricular performance in patients with corrected tetralogy of Fallot.
OBJECTIVE
Right ventricular (RV) dysfunction is common in patients with corrected tetralogy of Fallot (cToF). Abnormalities in the temporal pattern of RV mechanical activation have been observed in patients with cToF, but the relationship with RV performance remains unclear. This study characterises RV performance and the temporal sequence of RV deformation in patients with cToF and healthy controls.


METHODS
37 patients with cToF were compared with 18 controls. Using two-dimensional speckle tracking analysis, global RV strain was assessed. In addition, time to peak strain and the time difference between RV inlet and RV outlet (RV time delay) was assessed.


METHODS
The relation between RV performance and RV time delay was assessed with linear regression analysis. Results RV strain was reduced in patients compared with controls (-20.9 ± 4.3% vs -30.7 ± 3.4%, p<0.001). Time to peak strain at the RV inlet showed no differences between patients with cToF and controls (406 ± 55 ms vs 405 ± 67 ms, p=0.429), whereas time to peak strain at the RV outlet was significantly delayed in patients with cToF (339 ± 75 ms vs 262 ± 85 ms, p=0.003). Consequently, RV time delay was significantly shorter in patients with cToF than in controls (66 ± 48 ms vs 143 ± 53 ms, p<0.001). A close relation between RV time delay and RV strain was observed (r=-0.70, p<0.001).


CONCLUSIONS
In patients with cToF, RV outlet deformation is delayed, causing a reduction in RV time delay which is significantly related to impairment in RV performance.
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Annelies E
AE
van der Hulst
Arno A W
AA
Roest
Victoria
V
Delgado
Eduard R
ER
Holman
Albert
A
de Roos
Nico A
NA
Blom
Jeroen J
JJ
Bax
D000293:Adolescent; D002648:Child; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology