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Predicting Regurgitant Fraction in Pediatric Patients with Repaired Fallot Using Right Ventricular Strain
Antoine Fakhry AbdelMassih1,2, Amal El-Sisi1, Asmaa Abdel Hamid3
1Department of Pediatrics, Pediatric Cardiology Unit, Cairo University Children Hospital, Cairo University, Cairo, Egypt.
Insights
Right ventricular global longitudinal strain (RV GLS) <11% can predict severe pulmonary regurgitation in Tetralogy of Fallot patients, aiding decisions for pulmonary valve replacement.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Pulmonary regurgitation is a primary reason for re-intervention in Tetralogy of Fallot (TOF) patients.
- Current criteria for pulmonary valve replacement (PVR) rely on cardiac magnetic resonance (CMR) imaging.
- Novel echocardiographic methods are needed to assess PVR indications.
Purpose of the Study:
- To evaluate three-dimensional (3D) echocardiography-derived right ventricular (RV) indices, specifically RV global longitudinal strain (GLS), as predictors of pulmonary regurgitation (PR).
- To determine if RV GLS can facilitate timely referral for PVR in repaired TOF patients.
Main Methods:
- 3D speckle tracking echocardiography and 3D volumetry were performed on TOF patients with recent CMR data.
- 42 controls were included for benchmarking echocardiographic measurements.
- Echocardiography-derived RV and left ventricle (LV) volumes and longitudinal strain were analyzed for diagnostic accuracy in predicting PR.
Main Results:
- Good correlation was observed between CMR and echocardiography-derived ventricular volumes (Bland-Altmann analysis).
- RV GLS <11% demonstrated high sensitivity and specificity in predicting severe pulmonary regurgitation.
- Volume differences between CMR and echocardiography were less pronounced in the LV than in the RV.
Conclusions:
- RV GLS shows promise as a non-invasive imaging biomarker for assessing PR severity in repaired TOF.
- A cutoff of RV GLS <11% may aid in identifying patients requiring PVR.
- While limited by sample size, this study offers a new diagnostic approach for TOF management.
Background:
The major cause of re-intervention in Fallot patients (tetralogy of Fallot [TOF]) is pulmonary regurgitation. Current cutoffs for pulmonary valve replacement (PVR) are all cardiac magnetic resonance (CMR) derived, based on the regurgitant fraction (RF) and/or right ventricular end-diastolic volume index. In this study, we aimed at determining if three-dimensional (3D)-derived right ventricular indices, notably RV global longitudinal strain (GLS), can act as a predictor for RF and hence facilitate the decision-making and timely referral of such patients.
Methodology:
For this purpose, 3D volumetry and speckle tracking echocardiography has been performed on Fallot patients, with recent CMR in the past 6 months, 42 controls were included to benchmark echocardiographic results. Echocardiography-derived left ventricle (LV) and right ventricle (RV) volumes as well as longitudinal strain were calculated and tested for diagnostic accuracy to predict RF.
Results:
Bland-Altmann analyses showed a good correlation between volumes obtained by CMR and those obtained by echocardiography, differences in volumes between CMR and echocardiography derived volumes were less evident in the LV compared to the RV, RV GLS <11% was sensitive and specific in predicting severe pulmonary regurge.
Conclusion:
The study of strains, particularly RV strains in repaired TOF patients, is not new to the literature. However, to our knowledge, previous studies did not attempt to determine a cutoff of RV GLS in predicting severe PR and subsequent need for PVR, the findings of this study are limited by a small sample size, but they open new horizons in the diagnostics of repaired TOF patients.
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