title: Systemic right ventricular longitudinal strain is reduced in adults with transposition of the great arteries, relates to subpulmonary ventricular function, and predicts adverse clinical outcome.
abstract: BACKGROUND
  Transposition of the great arteries (TGA) after atrial switch operation and congenitally corrected TGA (ccTGA) are commonly associated with impaired systemic right ventricular (RV) function and impaired prognosis. We aimed to investigate the value of indices of myocardial deformation on speckle-tracking echocardiography for quantifying ventricular function and their potential role in assessing ventricular-ventricular interaction and outcome in patients with a systemic RV.
  
  
  RESULTS
  A total of 129 patients (87 with TGA and atrial switch and 42 with ccTGA, 71 men, age 35 ± 12 years) were investigated, and biventricular myocardial deformation was compared with findings in healthy subjects (n = 38, age 36 ± 10 years). Systemic ventricular longitudinal 2-dimensional (2D) peak systolic strain (RV 2D-LS) was significantly reduced compared with controls (-12.9 ± 3.6 and -15.4 ± 5.1 vs -21.0 ± 5.5 in TGAs, ccTGAs, and controls, P < .0001). Systemic and pulmonary 2D-LS were correlated in patients with TGA (r = 0.46, P < .0001) and ccTGA (r = 0.64, P < .0001), suggesting interventricular interaction, and this was confirmed when ejection fraction on magnetic resonance imaging was assessed (r = 0.53, P < .0001). More importantly, systemic 2D-LS (hazard ratio 1.31, P = .01) was related to adverse clinical outcome (symptomatic progression to New York Heart Association class ≥3, clinically relevant cardiac arrhythmia, or death) in patients with TGA and atrial switch independently of ejection fraction on cardiac magnetic resonance imaging, history of clinically relevant arrhythmia, or functional class.
  
  
  CONCLUSIONS
  Global longitudinal systolic strain is significantly reduced in patients with a systemic RV, is related to subpulmonary ventricular function, and predicts adverse clinical outcome in adults with atrial switch TGA.
authors.affiliation: Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, United Kingdom. gerhard.diller@ukmuenster.de
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
authors.forename: Jelena
authors.initials: J
authors.lastname: Radojevic
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kempny
authors.forename: Rafael
authors.initials: R
authors.lastname: Alonso-Gonzalez
authors.forename: Liodakis
authors.initials: L
authors.lastname: Emmanouil
authors.forename: Stefan
authors.initials: S
authors.lastname: Orwat
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.forename: Anselm
authors.initials: A
authors.lastname: Uebing
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.forename: Helmut
authors.initials: H
authors.lastname: Baumgartner
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000379:methods; D016022:Case-Control Studies; D000080041:Congenitally Corrected Transposition of the Great Arteries; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013312:Stress, Physiological; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D013599:Systole; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D016276:Ventricular Function / Q000502:physiology; D055815:Young Adult