title: Changes in speckle tracking echocardiography measures of ventricular function after percutaneous implantation of the Edwards SAPIEN transcatheter heart valve in the pulmonary position.
abstract: BACKGROUND
  Patients with free pulmonary regurgitation or mixed pulmonary stenosis and regurgitation and severely dilated right ventricles (RV) show little improvement in ventricular function after pulmonary valve replacement when assessed by traditional echocardiographic markers. We evaluated changes in right and left ventricular (LV) function using speckle tracking echocardiography in patients after SAPIEN transcatheter pulmonary valve (TPV) placement.
  
  
  METHODS
  Echocardiograms were evaluated at baseline, discharge, 1 and 6 months after TPV placement in 24 patients from 4 centers. Speckle tracking measures of function included peak longitudinal strain, strain rate, and early diastolic strain rate. RV fractional area change, tricuspid annular plane systolic excursion, and left ventricular LV ejection fraction were assessed. Routine Doppler and tissue Doppler velocities were measured.
  
  
  RESULTS
  At baseline, all patients demonstrated moderate to severe pulmonary regurgitation; this improved following TPV placement. No significant changes were detected in conventional measures of RV or LV function at 6 months. RV longitudinal strain (-16.9% vs. -19.6%, P < 0.01), strain rate (-0.87 s(-1) vs. -1.16 s(-1) , P = 0.01), and LV longitudinal strain (-16.2% vs. -18.2%, P = 0.01) improved between baseline and 6 month follow-up. RV early diastolic strain rate, LV longitudinal strain rate and early diastolic strain rate showed no change.
  
  
  CONCLUSIONS
  Improvements in RV longitudinal strain, strain rate, and LV longitudinal strain are seen at 6 months post-TPV. Diastolic function does not appear to change at 6 months. Speckle tracking echocardiography may be more sensitive than traditional measures in detecting changes in systolic function after TPV implantation.
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Shahryar M
authors.initials: SM
authors.lastname: Chowdhury
authors.forename: Ziyad M
authors.initials: ZM
authors.lastname: Hijazi
authors.forename: John F
authors.initials: JF
authors.lastname: Rhodes
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
authors.forename: Qi-Ling
authors.initials: QL
authors.lastname: Cao
authors.forename: Lazar
authors.initials: L
authors.lastname: Mandinov
authors.forename: Jason
authors.initials: J
authors.lastname: Buckley
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Pietris
authors.forename: Girish S
authors.initials: GS
authors.lastname: Shirali
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D038622:Internationality; D008297:Male; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000517:prevention & control
keywords: cardiac imaging; congenital heart disease; pulmonary valve; right ventricular function; strain-strain rate