Best Parameter for the Evaluation of Right Ventricular Function by 2D Echocardiography in Patients With Corrected Tetralogy of Fallot

Document Type: Original Article

Authors

1 Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran.

3 Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

Abstract

Background:Echocardiography has a widespread role in measuring cardiac function and hemodynamics. Nevertheless, the evaluation of right ventricular (RV) function is a puzzle, especially by 2D echocardiography, because of the complex anatomy of this chamber. Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, and an accurate evaluation of RV function is important for planning the time for pulmonary valve surgery after initial correcting surgery. Although cardiovascular magnetic resonance imaging (CMR) is the gold standard tool for measuring the right ventricular ejection fraction (RVEF), we sought to determine which classic factor for the evaluation of RV function by 2D echocardiography matched relevant CMR findings the most.
 
Methods:All patients (N = 26) with corrected ToF referred for CMR in Rajaie Cardiovascular Medical and Research Center between June 2018 and January 2019 were evaluated by 2D echocardiography. The findings relating to RV function by the 2 methods were analyzed using the SPSS software, version 22.
 
Results:Of the 4 classic parameters for the evaluation of RV function by 2D echocardiography, only fractional area change had a statistically significant correlation with RVEF by CMR (AUC for the evaluation of RVEF ≥ 45%: 0.813, P = 0.012; the Spearman correlation coefficient: 0.40, P = 0.04). Additionally, tricuspid annular plane systolic excursion, S’, and the RV index of myocardial performance could not predict RVEF in our patients with corrected ToF.
 
Conclusions: Fractional area change is a suitable parameter for the evaluation of RVEF in patients with ToF; nonetheless, the other classic parameters of RV function in 2D echocardiography cannot predict RV function in these patients. (Iranian Heart Journal 2020; 21(3): 40-47)

Keywords


 

1.       Iriart X, Montaudon M, Lafitte S, Chabaneix J, Réant P, Balbach T, et al., Right ventricle three-dimensional echography in corrected tetralogy of Fallot: accuracy and variability. European Journal of Echocardiography, 2009. 10(6): p. 784-792.

 

2.       Koestenberger M, Nagel B, Ravekes W, Everett AD, Stueger HP, Heinzl B, et al., Systolic right ventricular function in pediatric and adolescent patients with tetralogy of Fallot: echocardiography versus magnetic resonance imaging. Journal of the American Society of Echocardiography, 2011. 24(1): p. 45-52.

 

3.       Menting ME, van den Bosch AE, McGhie JS, Eindhoven JA, Cuypers JA, Witsenburg M, et al., Assessment of ventricular function in adults with repaired Tetralogy of Fallot using myocardial deformation imaging. European Heart Journal-Cardiovascular Imaging, 2015. 16(12): p. 1347-1357.

 

4.       Mercer-Rosa L, Parnell A, Forfia PR, Yang W, Goldmuntz E, Kawut SM, et al., Tricuspid annular plane systolic excursion in the assessment of right ventricular function in children and adolescents after repair of tetralogy of Fallot. J Am Soc Echocardiogr, 2013. 26(11): p. 1322-9.

 

5.       van der Hulst AE, Roest AA, Holman ER, de Roos A, Blom NA, Bax JJ, et al., Real-time three-dimensional echocardiography: segmental analysis of the right ventricle in patients with repaired tetralogy of Fallot. Journal of the American Society of Echocardiography, 2011. 24(11): p. 1183-1190.

 

6.       Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al., 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019. 139(14): p. e698-e800.

 

7.       Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al., Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 2015. 16(3): p. 233-70.

 

8.       Addetia K, Maffessanti F, Muraru D, Singh A, Surkova E, Mor-Avi V, et al., Morphologic Analysis of the Normal Right Ventricle Using Three-Dimensional Echocardiography-Derived Curvature Indices. J Am Soc Echocardiogr, 2018. 31(5): p. 614-623.

 

9.       Mercer-Rosa L, Yang W, Kutty S, Rychik J, Fogel M, Goldmuntz E, et al., Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot: a comparative analysis of echocardiography and magnetic resonance imaging. Circulation: Cardiovascular Imaging, 2012. 5(5): p. 637-643.

 

10.    Schwerzmann M, Samman AM, Salehian O, Holm J, Provost Y, Webb GD, et al., Comparison of echocardiographic and cardiac magnetic resonance imaging for assessing right ventricular function in adults with repaired tetralogy of fallot. Am J Cardiol, 2007. 99(11): p. 1593-7.

 

11.    Dragulescu A, Grosse-Wortmann L, Fackoury C, Riffle S, Waiss M, Jaeggi E, et al., Echocardiographic assessment of right ventricular volumes after surgical repair of tetralogy of Fallot: clinical validation of a new echocardiographic method. Journal of the American Society of Echocardiography, 2011. 24(11): p. 1191-1198.

 

12.    Koestenberger M, Nagel B, Avian A, Ravekes W, Sorantin E, Cvirn G, et al., Systolic right ventricular function in children and young adults with pulmonary artery hypertension secondary to congenital heart disease and tetralogy of Fallot: tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging data. Congenit Heart Dis, 2012. 7(3): p. 250-8.

 

13.    Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fandl A, et al., Tricuspid annular peak systolic velocity (S') in children and young adults with pulmonary artery hypertension secondary to congenital heart diseases, and in those with repaired tetralogy of Fallot: echocardiography and MRI data. J Am Soc Echocardiogr, 2012. 25(10): p. 1041-9.

 

14.    Egbe AC, Pislaru SV, Kothapalli S, Jadav R, Masood M, Angirekula M, et al., The role of echocardiography for quantitative assessment of right ventricular size and function in adults with repaired tetralogy of Fallot. Congenit Heart Dis, 2019.

 

15.   Ishizu T, Seo Y, Atsumi A, Tanaka YO, Yamamoto M, Machino-Ohtsuka T, et al., Global and Regional Right Ventricular Function Assessed by Novel Three-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr, 2017. 30(12): p. 1203-1213.

 

 

1.       Iriart X, Montaudon M, Lafitte S, Chabaneix J, Réant P, Balbach T, et al., Right ventricle three-dimensional echography in corrected tetralogy of Fallot: accuracy and variability. European Journal of Echocardiography, 2009. 10(6): p. 784-792.

2.       Koestenberger M, Nagel B, Ravekes W, Everett AD, Stueger HP, Heinzl B, et al., Systolic right ventricular function in pediatric and adolescent patients with tetralogy of Fallot: echocardiography versus magnetic resonance imaging. Journal of the American Society of Echocardiography, 2011. 24(1): p. 45-52.

3.       Menting ME, van den Bosch AE, McGhie JS, Eindhoven JA, Cuypers JA, Witsenburg M, et al., Assessment of ventricular function in adults with repaired Tetralogy of Fallot using myocardial deformation imaging. European Heart Journal-Cardiovascular Imaging, 2015. 16(12): p. 1347-1357.

4.       Mercer-Rosa L, Parnell A, Forfia PR, Yang W, Goldmuntz E, Kawut SM, et al., Tricuspid annular plane systolic excursion in the assessment of right ventricular function in children and adolescents after repair of tetralogy of Fallot. J Am Soc Echocardiogr, 2013. 26(11): p. 1322-9.

5.       van der Hulst AE, Roest AA, Holman ER, de Roos A, Blom NA, Bax JJ, et al., Real-time three-dimensional echocardiography: segmental analysis of the right ventricle in patients with repaired tetralogy of Fallot. Journal of the American Society of Echocardiography, 2011. 24(11): p. 1183-1190.

6.       Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al., 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019. 139(14): p. e698-e800.

7.       Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al., Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 2015. 16(3): p. 233-70.

8.       Addetia K, Maffessanti F, Muraru D, Singh A, Surkova E, Mor-Avi V, et al., Morphologic Analysis of the Normal Right Ventricle Using Three-Dimensional Echocardiography-Derived Curvature Indices. J Am Soc Echocardiogr, 2018. 31(5): p. 614-623.

9.       Mercer-Rosa L, Yang W, Kutty S, Rychik J, Fogel M, Goldmuntz E, et al., Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot: a comparative analysis of echocardiography and magnetic resonance imaging. Circulation: Cardiovascular Imaging, 2012. 5(5): p. 637-643.

10.    Schwerzmann M, Samman AM, Salehian O, Holm J, Provost Y, Webb GD, et al., Comparison of echocardiographic and cardiac magnetic resonance imaging for assessing right ventricular function in adults with repaired tetralogy of fallot. Am J Cardiol, 2007. 99(11): p. 1593-7.

11.    Dragulescu A, Grosse-Wortmann L, Fackoury C, Riffle S, Waiss M, Jaeggi E, et al., Echocardiographic assessment of right ventricular volumes after surgical repair of tetralogy of Fallot: clinical validation of a new echocardiographic method. Journal of the American Society of Echocardiography, 2011. 24(11): p. 1191-1198.

12.    Koestenberger M, Nagel B, Avian A, Ravekes W, Sorantin E, Cvirn G, et al., Systolic right ventricular function in children and young adults with pulmonary artery hypertension secondary to congenital heart disease and tetralogy of Fallot: tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging data. Congenit Heart Dis, 2012. 7(3): p. 250-8.

13.    Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fandl A, et al., Tricuspid annular peak systolic velocity (S') in children and young adults with pulmonary artery hypertension secondary to congenital heart diseases, and in those with repaired tetralogy of Fallot: echocardiography and MRI data. J Am Soc Echocardiogr, 2012. 25(10): p. 1041-9.

14.    Egbe AC, Pislaru SV, Kothapalli S, Jadav R, Masood M, Angirekula M, et al., The role of echocardiography for quantitative assessment of right ventricular size and function in adults with repaired tetralogy of Fallot. Congenit Heart Dis, 2019.

15.   Ishizu T, Seo Y, Atsumi A, Tanaka YO, Yamamoto M, Machino-Ohtsuka T, et al., Global and Regional Right Ventricular Function Assessed by Novel Three-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr, 2017. 30(12): p. 1203-1213.