Mechanical stress is associated with right ventricular response to pulmonary valve replacement in patients with repaired tetralogy of Fallot.
Mechanical stress is associated with right ventricular response to pulmonary valve replacement in patients with repaired tetralogy of Fallot.
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DOI：
10.1016/j.jtcvs.2015.09.106
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发表时间：
2016-03
期刊：
影响因子：
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通讯作者：
Geva T
中科院分区：
文献类型：
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作者：
Tang D;Yang C;Del Nido PJ;Zuo H;Rathod RH;Huang X;Gooty V;Tang A;Billiar KL;Wu Z;Geva T
法洛四联症（TOF）修复患者占晚发性右心室（RV）衰竭病例的很大比例。目前的手术方法，包括肺动脉瓣置换/插入术（PVR），产生了混合的结果。因此，确定可能用于预测PVR的RV功能反应的参数可能在临床上有用。心脏磁共振（CMR）数据之前和PVR后6个月获得16例TOF修复患者（8个月，8个月，中位年龄42.75）。将PVR前后的RV射血分数（EF）变化用作结局。将患者分为第1组（n=8，结局较好）和第2组（n=8，结局最差）。构建基于CMR的患者特定计算RV/LV模型，并获得RV机械应力和应变、壁厚（WT）、曲率和体积以供分析。我们的研究结果表明，右心室壁应力是PRV后结局的最佳单一预测因子，受试者工作特征曲线下面积为0.819。两组之间的应力、应变、WT和纵向曲率的平均值存在显著差异，RV壁应力显示出最大差异。第2组的平均RV应力比第1组高103%。计算模型和RV应力可作为一种潜在的工具，以确定RV功能对PVR的反应。需要大规模的临床研究来验证这些初步发现。
Patients with repaired tetralogy of Fallot (TOF) account for a substantial proportion of cases with late-onset right ventricular (RV) failure. The current surgical approach, which includes pulmonary valve replacement/insertion (PVR), has yielded mixed results. Therefore, it may be clinically useful to identify parameters that can potentially be used to predict RV function response to PVR. Cardiac magnetic resonance (CMR) data before and 6-month after PVR were obtained from 16 patients with repaired TOF (8 m, 8 f, median age 42.75). RV ejection fraction (EF) change from pre- to post-PVR was used as the outcome. The patients were divided into Group 1 (n=8, better outcome) and Group 2 (n=8, worst outcome). CMR-based patient-specific computational RV/LV models were constructed and RV mechanical stress and strain, wall thickness (WT), curvature, and volumes were obtained for analysis. Our results indicated that RV wall stress was the best single predictor for post-PRV outcome with an area under the receiver operating characteristic curve of 0.819. Mean values of stress, strain, WT, and longitudinal curvature differed significantly between the two groups with RV wall stress showing the largest difference. Mean RV stress from Group 2 was 103% higher than that from Group 1. Computational modeling and RV stress may be used as a potential tool to identify RV function response to PVR. Large-scale clinical studies are needed to validate these preliminary findings.