title: Right ventricular function with standard and speckle-tracking echocardiography and clinical events in adults with D-transposition of the great arteries post atrial switch.
abstract: BACKGROUND
  The prognostic value of deformation parameters of the systemic right ventricle in adults with D-transposition of the great arteries and prior atrial switch has not been reported.
  
  
  METHODS
  Sixty-four adults with D-transposition of the great arteries and prior atrial switch (mean age, 29 ± 6 years; 22 women; mean right ventricular [RV] fractional area change, 22.9 ± 7.5%; 31 with pacemakers at baseline) and no histories of heart failure or ventricular tachycardia were prospectively evaluated. Global longitudinal strain (GS), global systolic strain rate (GSRs), and global early diastolic strain rate (GSRe) of the right ventricle were measured using speckle tracking from apical views and compared with standard parameters of RV function (fractional area change, tricuspid annular plane systolic excursion, tissue Doppler velocities, and isovolumic acceleration) for association with and potential prediction of clinical events, defined as incident stage C heart failure or ventricular tachycardia.
  
  
  RESULTS
  Baseline RV GS, GSRs, and GSRe were -12.5 ± 3.0%, -0.59 ± 0.14 sec(-1), and 0.68 ± 0.22 sec(-1), respectively. After a median of 2.4 years (interquartile range, 1.5-4.1 years), 12 patients (19%) presented with clinical events (heart failure in 11 patients, ventricular tachycardia in one patient). In Cox models, RV GS had the strongest association with clinical events (hazard ratio [HR] per 1%, 1.35; 95% confidence interval [CI], 1.14-1.58; P < .001), followed by GSRs (HR per 0.01 sec(-1), 1.06; 95% CI, 1.02-1.11; P = .006), GSRe (HR per -0.01 sec(-1), 1.04; 95% CI, 1.00-1.07; P = .031), and fractional area change (HR per -1%, 1.08; 95% CI, 1.00-1.17; P = .047). Other measures of RV function were not significantly associated with risk for events. In receiver operating characteristic analysis, RV GS ≥ -10% optimally predicted future events (C = 0.83; 95% CI, 0.71-0.91; P < .001).
  
  
  CONCLUSIONS
  Reduced longitudinal GS of the systemic right ventricle is associated with increased risk for clinical events among patients with D-transposition of the great arteries and prior atrial switch.
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA. akaloge@emory.edu
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kalogeropoulos
authors.forename: Anjan
authors.initials: A
authors.lastname: Deka
authors.forename: William
authors.initials: W
authors.lastname: Border
authors.forename: Maria A
authors.initials: MA
authors.lastname: Pernetz
authors.forename: Vasiliki V
authors.initials: VV
authors.lastname: Georgiopoulou
authors.forename: Jawad
authors.initials: J
authors.lastname: Kiani
authors.forename: Michael
authors.initials: M
authors.lastname: McConnell
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Randolph P
authors.initials: RP
authors.lastname: Martin
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Book
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D004452:Echocardiography / Q000295:instrumentation*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D011184:Postoperative Period; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012306:Risk; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016278:Ventricular Function, Right / Q000502:physiology