Vos, J.D.L. (Johannes) (2017) Characterization and clinical significance of right ventricular mechanics in patients with repaired Tetralogy of Fallot: a cardiac magnetic resonance imaging study. thesis, Medicine.
Full text available on request.Abstract
Aims Patients with tetralogy of Fallot (ToF) generally suffer from pulmonary regurgitation (PR) and/or residual pulmonary stenosis (PS) after surgical repair. Regular cardiac assessment is required to evaluate right ventricular (RV) adaptation and function in response to the abnormal loading conditions. However, global measures such as RV ejection fraction (RVEF) may not be sensitive enough to detect subtle changes in RV function. Feature tracking cardiac magnetic resonance (FT-CMR) analysis is a novel post-processing technique allowing for regional quantification of myocardial deformation on standard CMR images. This study was designed to evaluate the effect of RV dimensions (volumes and mass) to deformation patterns obtained by FT-CMR and to compare with ejection fraction. Methods Cardiac magnetic resonance imaging data were retrospectively analyzed. We assessed the associations between RV deformation and RV volumes, mass and function. Results CMR images of 158 subjects were analyzed. RV end-diastolic volume indexed for body surface area (RVEDVi) correlated with RVEF only (r=-0.220, p<0.01). RV end-systolic volume index (RVESVi) correlated with RVEF (r=- 0.630, p<0.001), global circumferential strain (RVGCS) (r=0.352, p<0.001), circumferential systolic strain rate (RVCSRsystolic) (r=0.290, p<0.001) and diastolic strain rate (RVCSRdiastolic) (r=-0.274, p<0.001). RV mass index (RVMi) correlated with RVEF (r=-0.187, p<0.05), RV global longitudinal strain (RVGLS) (r=0.190, p<0.05), RV free wall systolic (RVLSRfree_wall_systolic) (r=0.225, p<0.01) and diastolic strain rate (RVLSRfree_wall_diastolic) (r=0.337, p<0.001). RV mass/volume ratio (RVM/V) expressed correlations with RVGLS (r=0.335, p<0.001), RVLSRfree_wall_systolic (r=0.291, p<0.001) and RVLSRfree_wall_diastolic (r=-0.286, p<0.001) but not with RVEF. RVEF correlated with RVGLS (r=-0.351, p<0.001), RVLSRfree_wall_systolic (r=-0.192, p<0.05), RVLSRfree_wall_diastolic (r=0.222, p<0.01), RVGCS (r=-0.488, p<0.001), RVCSRsystolic (r=-0.349, p<0.001), RVCSRdiastolic (r=-0.346, p<0.001). Conclusion FT-CMR analysis is a feasible and highly reproducible technique for quantifying myocardial contractility and provides better accuracy compared to ejection fraction. Absolute regional strain values are associated with EF, ventricular mass, mass/volume ratio and end-systolic volume and can alter independent of changes in EF. Therefore it is a highly potential technique for evaluating cardiac function and changes in contractility over time during the follow-up of patients with rToF.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Willems, Dr. T.P. MD/PhD and Cardiovascular Radiologist and Department of Radiology and University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/652 |
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