Impaired right and left ventricular diastolic myocardial mechanics and filling in asymptomatic children and adolescents after repair of tetralogy of Fallot

Mark K. Friedberg, Fernanda P. Fernandes, Susan L. Roche, Lars Grosse-Wortmann, Cedric Manlhiot, Cheryl Fackoury, Cameron Slorach, Brian W. Mccrindle, Luc Mertens, Paul F. Kantor

Research output: Contribution to journalArticle

Abstract

Aims: After tetralogy of Fallot (TOF) repair patients have right ventricular (RV) dysfunction and reduced exercise tolerance. Diastolic dysfunction may be important but is as yet poorly characterized. The early diastolic strain rate (SR) is a measure of ventricular relaxation, and may be useful to assess diastolic mechanics in TOF. We hypothesized that children after TOF repair have diastolic dysfunction and dyssynchrony by this measure, and sought to determine their relationship with pulmonary regurgitation (PR), RV enlargement, and aerobic exercise capacity. Methods and results: We prospectively recruited asymptomatic children after TOF repair. RV and PR volumes were measured by magnetic resonance imaging; Doppler and tissue Doppler indices by echocardiography and RV and left ventricular (LV) early diastolic SR by two-dimensional speckle tracking. Exercise peak oxygen consumption (VO 2) was determined using bicycle ergometry. Results were compared with healthy controls. We studied 53 TOF patients and 49 age-matched controls. TOF patients had significant PR (2.05 ± 1 L/m2) with moderate RV dilatation (157 ± 39 mL/m2), low-normal RV ejection fraction (49 ± 8.8), and moderate QRS prolongation (141 ± 23 ms). The RV outflow gradient was 21.7 ± 16.0 mmHg. Patients had RV diastolic dysfunction vs. controls [reduced tricuspid valve (TV) E/A ratio, E′ velocity, and longitudinal diastolic SR; increased right atrial volume and TV E/E′ ratio]. LV early diastolic radial and circumferential SR were lower in TOF patients in association with more PR [parameter estimate (PE) 0.177 standard error (SE) (0.08) mL/m2, P 0.02] and higher RV volumes [(PE) 0.005 (0.002)mL/m2, P 0.01]. Diastolic dyssynchrony was not different in TOF patients vs. controls. Conclusion: TOF patients have RV and LV diastolic dysfunction associated with RV enlargement and reduced early filling. SR imaging may be useful to quantify early myocardial diastolic dysfunction in these children.

Original languageEnglish (US)
Pages (from-to)905-913
Number of pages9
JournalEuropean heart journal cardiovascular Imaging
Volume13
Issue number11
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

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Tetralogy of Fallot
Mechanics
Pulmonary Valve Insufficiency
Patient Rights
Right Ventricular Dysfunction
Tricuspid Valve
Exercise
Ergometry
Exercise Tolerance
Doppler Echocardiography
Left Ventricular Dysfunction
Oxygen Consumption
Stroke Volume
Dilatation
Magnetic Resonance Imaging

Keywords

  • Diastole
  • Paediatrics
  • Speckle-tracking echocardiography
  • Strain rate
  • Tetralogy of Fallot

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Impaired right and left ventricular diastolic myocardial mechanics and filling in asymptomatic children and adolescents after repair of tetralogy of Fallot. / Friedberg, Mark K.; Fernandes, Fernanda P.; Roche, Susan L.; Grosse-Wortmann, Lars; Manlhiot, Cedric; Fackoury, Cheryl; Slorach, Cameron; Mccrindle, Brian W.; Mertens, Luc; Kantor, Paul F.

In: European heart journal cardiovascular Imaging, Vol. 13, No. 11, 01.11.2012, p. 905-913.

Research output: Contribution to journalArticle

Friedberg, MK, Fernandes, FP, Roche, SL, Grosse-Wortmann, L, Manlhiot, C, Fackoury, C, Slorach, C, Mccrindle, BW, Mertens, L & Kantor, PF 2012, 'Impaired right and left ventricular diastolic myocardial mechanics and filling in asymptomatic children and adolescents after repair of tetralogy of Fallot', European heart journal cardiovascular Imaging, vol. 13, no. 11, pp. 905-913. https://doi.org/10.1093/ehjci/jes067
Friedberg, Mark K. ; Fernandes, Fernanda P. ; Roche, Susan L. ; Grosse-Wortmann, Lars ; Manlhiot, Cedric ; Fackoury, Cheryl ; Slorach, Cameron ; Mccrindle, Brian W. ; Mertens, Luc ; Kantor, Paul F. / Impaired right and left ventricular diastolic myocardial mechanics and filling in asymptomatic children and adolescents after repair of tetralogy of Fallot. In: European heart journal cardiovascular Imaging. 2012 ; Vol. 13, No. 11. pp. 905-913.
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abstract = "Aims: After tetralogy of Fallot (TOF) repair patients have right ventricular (RV) dysfunction and reduced exercise tolerance. Diastolic dysfunction may be important but is as yet poorly characterized. The early diastolic strain rate (SR) is a measure of ventricular relaxation, and may be useful to assess diastolic mechanics in TOF. We hypothesized that children after TOF repair have diastolic dysfunction and dyssynchrony by this measure, and sought to determine their relationship with pulmonary regurgitation (PR), RV enlargement, and aerobic exercise capacity. Methods and results: We prospectively recruited asymptomatic children after TOF repair. RV and PR volumes were measured by magnetic resonance imaging; Doppler and tissue Doppler indices by echocardiography and RV and left ventricular (LV) early diastolic SR by two-dimensional speckle tracking. Exercise peak oxygen consumption (VO 2) was determined using bicycle ergometry. Results were compared with healthy controls. We studied 53 TOF patients and 49 age-matched controls. TOF patients had significant PR (2.05 ± 1 L/m2) with moderate RV dilatation (157 ± 39 mL/m2), low-normal RV ejection fraction (49 ± 8.8), and moderate QRS prolongation (141 ± 23 ms). The RV outflow gradient was 21.7 ± 16.0 mmHg. Patients had RV diastolic dysfunction vs. controls [reduced tricuspid valve (TV) E/A ratio, E′ velocity, and longitudinal diastolic SR; increased right atrial volume and TV E/E′ ratio]. LV early diastolic radial and circumferential SR were lower in TOF patients in association with more PR [parameter estimate (PE) 0.177 standard error (SE) (0.08) mL/m2, P 0.02] and higher RV volumes [(PE) 0.005 (0.002)mL/m2, P 0.01]. Diastolic dyssynchrony was not different in TOF patients vs. controls. Conclusion: TOF patients have RV and LV diastolic dysfunction associated with RV enlargement and reduced early filling. SR imaging may be useful to quantify early myocardial diastolic dysfunction in these children.",
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T1 - Impaired right and left ventricular diastolic myocardial mechanics and filling in asymptomatic children and adolescents after repair of tetralogy of Fallot

AU - Friedberg, Mark K.

AU - Fernandes, Fernanda P.

AU - Roche, Susan L.

AU - Grosse-Wortmann, Lars

AU - Manlhiot, Cedric

AU - Fackoury, Cheryl

AU - Slorach, Cameron

AU - Mccrindle, Brian W.

AU - Mertens, Luc

AU - Kantor, Paul F.

PY - 2012/11/1

Y1 - 2012/11/1

N2 - Aims: After tetralogy of Fallot (TOF) repair patients have right ventricular (RV) dysfunction and reduced exercise tolerance. Diastolic dysfunction may be important but is as yet poorly characterized. The early diastolic strain rate (SR) is a measure of ventricular relaxation, and may be useful to assess diastolic mechanics in TOF. We hypothesized that children after TOF repair have diastolic dysfunction and dyssynchrony by this measure, and sought to determine their relationship with pulmonary regurgitation (PR), RV enlargement, and aerobic exercise capacity. Methods and results: We prospectively recruited asymptomatic children after TOF repair. RV and PR volumes were measured by magnetic resonance imaging; Doppler and tissue Doppler indices by echocardiography and RV and left ventricular (LV) early diastolic SR by two-dimensional speckle tracking. Exercise peak oxygen consumption (VO 2) was determined using bicycle ergometry. Results were compared with healthy controls. We studied 53 TOF patients and 49 age-matched controls. TOF patients had significant PR (2.05 ± 1 L/m2) with moderate RV dilatation (157 ± 39 mL/m2), low-normal RV ejection fraction (49 ± 8.8), and moderate QRS prolongation (141 ± 23 ms). The RV outflow gradient was 21.7 ± 16.0 mmHg. Patients had RV diastolic dysfunction vs. controls [reduced tricuspid valve (TV) E/A ratio, E′ velocity, and longitudinal diastolic SR; increased right atrial volume and TV E/E′ ratio]. LV early diastolic radial and circumferential SR were lower in TOF patients in association with more PR [parameter estimate (PE) 0.177 standard error (SE) (0.08) mL/m2, P 0.02] and higher RV volumes [(PE) 0.005 (0.002)mL/m2, P 0.01]. Diastolic dyssynchrony was not different in TOF patients vs. controls. Conclusion: TOF patients have RV and LV diastolic dysfunction associated with RV enlargement and reduced early filling. SR imaging may be useful to quantify early myocardial diastolic dysfunction in these children.

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KW - Diastole

KW - Paediatrics

KW - Speckle-tracking echocardiography

KW - Strain rate

KW - Tetralogy of Fallot

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