title: The value of right ventricular longitudinal strain in the evaluation of adult patients with repaired tetralogy of Fallot: a new tool for a contemporary challenge.
abstract: OBJECTIVE
  The role of right ventricular longitudinal strain for assessing patients with repaired tetralogy of Fallot is not fully understood. In this study, we aimed to evaluate its relation with other structural and functional parameters in these patients.
  
  
  METHODS
  Patients followed-up in a grown-up CHD unit, assessed by transthoracic echocardiography, cardiac MRI, and treadmill exercise testing, were retrospectively evaluated. Right ventricular size and function and pulmonary regurgitation severity were assessed by echocardiography and MRI. Right ventricular longitudinal strain was evaluated in the four-chamber view using the standard semiautomatic method.
  
  
  RESULTS
  In total, 42 patients were included (61% male, 32±8 years). The mean right ventricular longitudinal strain was -16.2±3.7%, and the right ventricular ejection fraction, measured by MRI, was 42.9±7.2%. Longitudinal strain showed linear correlation with tricuspid annular systolic excursion (r=-0.40) and right ventricular ejection fraction (r=-0.45) (all p<0.05), which in turn showed linear correlation with right ventricular fractional area change (r=0.50), pulmonary regurgitation colour length (r=0.35), right ventricular end-systolic volume (r=-0.60), and left ventricular ejection fraction (r=0.36) (all p<0.05). Longitudinal strain (β=-0.72, 95% confidence interval -1.41, -0.15) and left ventricular ejection fraction (β=0.39, 95% confidence interval 0.11, 0.67) were independently associated with right ventricular ejection fraction. The best threshold of longitudinal strain for predicting a right ventricular ejection fraction of <40% was -17.0%.
  
  
  CONCLUSIONS
  Right ventricular longitudinal strain is a powerful method for evaluating patients with tetralogy of Fallot. It correlated with echocardiographic right ventricular function parameters and was independently associated with right ventricular ejection fraction derived by MRI.
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Almeida-Morais
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Pereira-da-Silva
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Branco
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Ana T
authors.initials: AT
authors.lastname: Timóteo
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Agapito
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Lídia
authors.initials: L
authors.lastname: de Sousa
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: José A
authors.initials: JA
authors.lastname: Oliveira
authors.affiliation: 2MRI Caselas,Lisbon,Portugal.
authors.forename: Boban
authors.initials: B
authors.lastname: Thomas
authors.affiliation: 2MRI Caselas,Lisbon,Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Jalles-Tavares
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Soares
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Galrinho
authors.affiliation: 1Department of Cardiology,Hospital de Santa Marta,Centro Hospitalar de Lisboa Central,Lisbon,Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Cruz-Ferreira
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: 2D-speckle tracking; Longitudinal strain; right ventricular function; tetralogy of Fallot