Biventricular dyssynchrony on cardiac magnetic resonance imaging and its correlation with myocardial deformation, ventricular function and objective exercise capacity in patients with repaired tetralogy of Fallot
Biventricular dyssynchrony on cardiac magnetic resonance imaging and its correlation with myocardial deformation, ventricular function and objective exercise capacity in patients with repaired tetralogy of Fallot
复制标题
DOI：
10.1016/j.ijcard.2018.04.005
复制
发表时间：
2018-08-01
影响因子：
3.5
通讯作者：
Diller, Gerhard-Paul
中科院分区：
文献类型：
--
作者：
Kalaitzidis, Pantelis;Orwat, Stefan;Diller, Gerhard-Paul
背景：电不同步和 QRS 持续时间延长在修复法洛四联症 (ToF) 患者中很常见。它与心源性猝死和右心室（RV）功能障碍的风险增加有关。我们在这种情况下使用心脏磁共振成像 (CMR) 和特征跟踪分析 (FT) 研究心肌不同步，并将其与心肌变形、心室功能障碍的常规参数和临床参数进行比较。 方法和结果：作为全国研究的一部分，患者接受了标准化 CMR 检查。我们使用 CMR-FT 前瞻性评估心肌变形并分析 RV 和左心室 (LV) 的局部室壁运动异常。不同步的主要衡量标准是区域应变的最大时间差（室壁运动延迟），作为机械双心室不同步的参数。此外，还可以获得心肺运动能力的临床参数和测量结果。总共包括 345 名患者。双心室壁运动延迟参数与全局 FT 应变参数显着相关（对于所有评估的成像平面，p < 0.0001）。此外，我们发现圆周 RV 运动延迟与 QRS 持续时间之间存在显着相关性 (p = 0.006)。较高的 LV 和 RV 室壁运动延迟参数还与较低的峰值耗氧量 (p < 0.05) 和较差的 LV 和 RV 射血分数 (p < 0.02) 相关。结论：在 ToF 患者中使用 CMR-FT 评估机械不同步是可行的。在这种情况下，机械不同步的参数与电不同步、双心室功能和客观运动能力相关。然而，由于相关性较弱，这些发现的临床意义仍有待进一步研究阐明。 (C) 2018 Elsevier B.V. 保留所有权利。
Background: Electrical dyssynchrony and prolonged QRS duration are common in patients with repaired tetralogy of Fallot (ToF). It has been linked to increased risk of sudden cardiac death and right ventricular (RV) dysfunction. We investigated myocardial dyssynchrony using cardiac magnetic resonance imaging (CMR) and feature tracking analysis (FT) in this setting and compared it to myocardial deformation, conventional parameters of ventricular dysfunction and clinical parameters.Methods and results: Patients underwent standardized CMR investigations as part of a nationwide study. We prospectively assessed myocardial deformation and analysed regional wall motion abnormalities of the RV and the left ventricle (LV) using CMR-FT. The main measure of dyssynchrony was the maximal time difference (wall motion delay) of the regional strain as a parameter of mechanical biventricular dyssynchrony. In addition, clinical parameters and measures of cardiopulmonary exercise capacity were available. Overall 345 patients were included. Parameters of biventricular wall motion delay correlated significantly with global FT-strain parameters (p < 0.0001 for all imaging planes assessed). Furthermore, we found a significant correlation between circumferential RV motion delay and QRS duration (p = 0.006). Higher LV and RV wall motion delay parameters were also associated with lower peak oxygen consumption (p < 0.05) and a worse LV and RV ejection fraction (p < 0.02).Conclusions: Assessment of mechanical dyssynchrony is feasible using CMR-FT in ToF patients. Parameters of mechanical dyssynchrony correlate with electrical dyssynchrony, biventricular function and objective exercise capacity in this setting. Due to the weak degree of correlation, however, the clinical significance of these findings remains to be clarified by further studies. (C) 2018 Elsevier B.V. All rights reserved.