Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of Fallot: New insights in cardiac mechanics and exercise capacity
Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of Fallot: New insights in cardiac mechanics and exercise capacity
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DOI：
10.1016/j.ijcard.2020.07.026
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发表时间：
2020-12-15
影响因子：
3.5
通讯作者：
Di Salvo, Giovanni
中科院分区：
文献类型：
--
作者：
Avesani, Martina;Borrelli, Nunzia;Di Salvo, Giovanni
背景：法乐四联症修补术(r-TOF)患者普遍存在肺返流(PR)和右室(RV)扩张和功能障碍。目的：在PR显著的r-TOF儿童人群中，比较超声心动图和金标准CMR，评价标准和高级回声参数的可靠性。方法和结果：所有患者均接受标准回声多普勒检查、斑点追踪分析和CMR检查，以评估PR和RV的大小和功能。36例患者还接受了心肺运动试验。46例患者，年龄13.7+/-3.0岁。回声来源的RV面积与CMR RV体积相关(p<；.0001，r=0.72)。右室舒张末面积N 21.9 cm~2/m~2对确定右室舒张末容量<150ml/m~2有较好的敏感性(83.3%)和特异性(73.5%)。所有患者RVEF保留，Tapse减少78.2%，RVGLS减少60.8%。肺分支血流逆转判断CMR肺返流分数(RF)=35%的敏感性为95.8%，特异性为59.1%。CMR各参数与最大VO2均无相关性。在超声心动图数据中，只有右房应变(RAS)与VO2峰值相关。结论：在儿童中，肺分支血流反转诊断血流动力学有意义的RF具有较好的敏感性，但特异性较差。超声心动图显示右室面积是筛选右室扩张的有效一线参数。右室纵向收缩功能障碍与仍保留的EF并存。RAS与VO2峰值密切相关，应在随访时加用。(C)2020爱思唯尔B.V.保留所有权利。
Background: Pulmonary regurgitation (PR) and right ventricular (RV) dilatation and disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF).Aims: To compare Echo datawith the gold standard CMR in a paediatric population of r-TOFwith significant PR, to assess the reliability of standard and advanced echo parameters. In addition, to evaluate their correlation with peak oxygen consumption (VO2).Methods and results: All patients underwent standard echo-Doppler study, speckle tracking analysis, and CMR to assess PR and RV size and function. Thirty-six patients underwent also cardiopulmonary exercise test. Fourty-six patients (aged 13.7 +/- 3.0) were included. Echo derived RV areas correlated with CMR RV volumes (p < .0001, r = 0.72). RV end-diastolic area N 21.9 cm2/m2 had a good sensitivity (83.3%) and specificity (73.5%) to identify a RV end-diastolic volume >= 150 ml/m(2). RVEF was preserved in all patients, while TAPSE was reduced in 78.2% and RVGLS in 60.8%. Flow-reversal in pulmonary branches showed a sensitivity of 95.8% and a specificity of 59.1% to identify CMRpulmonary regurgitant fraction (RF) = 35%. None of the CMRparameters correlated with peak VO2. Among the Echo data only right atrial strain (RAS) correlated with peak VO2.Conclusion: In children, flow-reversal in pulmonary branches identifies hemodynamically significant RF with a good sensitivity but poor specificity. RV area by echocardiogramis a valid first-line parameter to screen RV dilation. RV longitudinal systolic dysfunction coexistswith a still preserved EF. RAS correlates stronglywith peak VO2 and should be added in their follow up. (C) 2020 Elsevier B.V. All rights reserved.