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Published on: May 13, 2019
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Frequent Activation Delay-Induced Mechanical Dyssynchrony and Dysfunction in the Systemic Right Ventricle
Daniel Forsha1, Niels Risum2, P Brian Smith3
1Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri.
Summary
Systemic right ventricles show reduced function and increased dyssynchrony. A classic strain pattern, indicative of activation delays, was common in patients with d-transposition of the great arteries after Mustard or Senning palliation.
Area of Science:
- Cardiology
- Cardiac Imaging
- Electrophysiology
Background:
- Patients with systemic right ventricles often develop heart failure and conduction abnormalities.
- Abnormal ventricular activation and mechanical dyssynchrony contribute to heart failure.
- A classic strain pattern predicts response to cardiac resynchronization therapy in left bundle branch block.
Purpose of the Study:
- Compare right ventricular (RV) mechanics in adults with systemic RV (TGA-MS) versus controls.
- Evaluate the feasibility of RV strain pattern analysis for mechanical dyssynchrony.
- Determine the frequency of the classic strain pattern in TGA-MS patients.
Main Methods:
- Ambispective enrollment of 25 TGA-MS patients and prospective enrollment of 30 healthy controls.
- Utilized three-apical view (18-segment) RV longitudinal speckle-tracking strain analysis (EchoPAC).
- Collected and analyzed electrocardiographic data.
Main Results:
- TGA-MS patients exhibited diminished RV global peak systolic strain (-12.0 ± 4.0%) compared to controls (-23.3 ± 2.3%).
- A classic strain pattern was present in 44% (11/25) of TGA-MS patients.
- The classic pattern was associated with activation delays and predicted response to cardiac resynchronization therapy.
Conclusions:
- Systemic right ventricles show decreased function and increased mechanical dyssynchrony.
- The classic strain pattern of dyssynchrony is frequently observed in TGA-MS patients.
- Comprehensive RV strain analysis provides valuable insights into ventricular mechanics and response to therapy.
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