title: Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation.
abstract: BACKGROUND
  Speckle-tracking echocardiographic (STE) measures of right ventricular (RV) function appear to improve after transcatheter pulmonary valve implantation (TPVI). Measures of exercise function, such as ventilatory efficiency (the minute ventilation [VE]/carbon dioxide production [VCO2] slope), have been shown to be prognostic of mortality in patients who may require TPVI. The aim of this study was to evaluate the correlation between STE measures of RV function and changes in VE/VCO2 after TPVI.
  
  
  METHODS
  Speckle-tracking echocardiography and cardiopulmonary exercise testing were performed at baseline and 6 months after TPVI in 24 patients from four centers. Conventional echocardiographic measures of RV function were also assessed. Echocardiographic and exercise stress test results were interpreted by single blinded observers at separate core laboratories.
  
  
  RESULTS
  All patients demonstrated relief of pulmonary regurgitation and stenosis after TPVI. Improvements in RV longitudinal strain (-16.9 ± 3.5% vs -19.7 ± 4.3%, P < .01) and strain rate (-0.9 ± 0.4 vs. -1.2 ± 0.4 s(-1), P < .01) were noted. The VE/VCO2 slope improved (32.4 ± 5.7 vs 31.5 ± 8.8, P = .03). No other significant echocardiographic or exercise changes were found. On multivariate regression, the change in VE/VCO2 was independently associated with change in RV longitudinal early diastolic strain rate (P < .001) and tricuspid A velocity (P < .001). Preintervention RV longitudinal strain was found to be a predictor of change in VE/VCO2 after TPVI (r = -0.60, P < .001).
  
  
  CONCLUSIONS
  STE measures of RV function appear to hold the potential for use as predictors of improved outcomes in patients requiring TPVI. Future studies should directly assess the prognostic significance of STE measures of RV function in this population.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: chowdhur@musc.edu.
authors.forename: Shahryar M
authors.initials: SM
authors.lastname: Chowdhury
authors.affiliation: Department of Pediatrics, Sidra Medical and Research Center, Doha, Qatar.
authors.forename: Ziyad M
authors.initials: ZM
authors.lastname: Hijazi
authors.affiliation: Department of Pediatrics, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: John T
authors.initials: JT
authors.lastname: Fahey
authors.affiliation: Department of Pediatrics, Miami Children's Hospital, Miami, Florida.
authors.forename: John F
authors.initials: JF
authors.lastname: Rhodes
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.affiliation: Department of Medicine, The Heart Hospital, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
authors.affiliation: Rush Center for Congenital & Structural Heart Disease, Rush University Medical Center, Chicago, Illinois.
authors.forename: Qi-Ling
authors.initials: QL
authors.lastname: Cao
authors.affiliation: The Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri.
authors.forename: Girish S
authors.initials: GS
authors.lastname: Shirali
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Congenital heart disease; Speckle-tracking echocardiography; Transcatheter pulmonary valve implantation