title: Multivariable assessment of the right ventricle by echocardiography in patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement: a comparative study with magnetic resonance imaging.
abstract: BACKGROUND
  Evaluation of the right ventricle (RV) using transthoracic echocardiography is challenging in patients with repaired tetralogy of Fallot (rTOF).
  
  
  OBJECTIVE
  To evaluate the accuracy of conventional echocardiographic variables and real-time three-dimensional echocardiography (RT3DE) in assessing right ventricular (RV) volumes and function compared with magnetic resonance imaging (MRI), in adult patients with rTOF and referred for pulmonary valve replacement (PVR).
  
  
  METHODS
  Complete echocardiography was performed on 26 consecutive patients referred for PVR, before and 1 year after surgery. All variables were compared with MRI.
  
  
  RESULTS
  Correlations between conventional variables and MRI were absent or poor when assessing RV ejection fraction (RVEF), except for fractional area of change (FAC; r=0.70, P<0.01 before PVR; r=0.68, P<0.01 after PVR) and RT3DE (r=0.96, P<0.01 before PVR; r=0.98, P<0.01 after PVR). The RV volume correlation between RT3DE and MRI was excellent before and after surgery for RV end-diastolic volume (r=0.88, P<0.01 and r=0.91, P<0.01, respectively) and RV end-systolic volume (r=0.92, P<0.01 and r=0.95, P<0.01, respectively). The accuracy of these indices, as a diagnostic test for impaired RV (<45%), was good: Youden's indexes varied from 0.47 to 0.89; areas under the receiver operating characteristic curve before and after PVR were 0.86 and 0.81 for FAC and 0.98 and 0.97 for RT3DE, respectively.
  
  
  CONCLUSIONS
  Commonly used echocardiography variables, such as tricuspid annular plane systolic excursion and tricuspid annular peak systolic velocity, did not sensitively evaluate global RVEF. A global approach, that includes the whole RV and integration of its different components, was more reliable in patients with rTOF.
authors.affiliation: Division of Congenital Heart Disease, Bordeaux Hospital University Center, avenue de Magellan, 33604 Bordeaux, France. Electronic address: bernardselly@hotmail.com.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Selly
authors.affiliation: Division of Congenital Heart Disease, Bordeaux Hospital University Center, avenue de Magellan, 33604 Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.affiliation: Division of Congenital Heart Disease, Bordeaux Hospital University Center, avenue de Magellan, 33604 Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Roubertie
authors.affiliation: Division of Congenital Heart Disease, Bordeaux Hospital University Center, avenue de Magellan, 33604 Bordeaux, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mauriat
authors.affiliation: Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Jan
authors.initials: J
authors.lastname: Marek
authors.affiliation: Division of Congenital Heart Disease, Bordeaux Hospital University Center, avenue de Magellan, 33604 Bordeaux, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Guilhon
authors.affiliation: Division of Pediatrics, Reunion Hospital University Center, Saint-Pierre, Reunion.
authors.forename: Karim
authors.initials: K
authors.lastname: Jamal-Bey
authors.affiliation: Division of Congenital Heart Disease, Bordeaux Hospital University Center, avenue de Magellan, 33604 Bordeaux, France.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D019560:Echocardiography, Three-Dimensional; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012372:ROC Curve; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right; D055815:Young Adult
keywords: Echocardiography; IRM; Magnetic resonance imaging; Pulmonary valve replacement; Remplacement valvulaire pulmonaire; Right ventricle; Tetralogy of Fallot; Tétralogie de Fallot; Ventricule droit; Échocardiographie