Biventricular myocardial adaptation in patients with repaired tetralogy of Fallot: Mechanistic insights from magnetic resonance imaging tissue phase mapping
Journal
PLoS ONE
Journal Volume
15
Journal Issue
8-Aug
Pages
e0237193
Date Issued
2020
Author(s)
Abstract
Background The myocardial adaptive mechanism in patients with repaired tetralogy of Fallot (rTOF) is less understood. We aimed to investigate biventricular myocardial adaptive remodeling in rTOF patients. Methods We recruited 32 rTOF patients and 38 age- and sex-matched normal controls. The pulmonary stenosis of rTOF patients was measured using catheterized pressure gradient between right ventricle (RV) and pulmonary artery (PGRVPA). rTOF patients with PGRVPA < 15 mmHg and ?15 mmHg were classified as low pulmonary stenosis (rTOFlow, n = 19) and high pulmonary stenosis (rTOFhigh, n = 13) subgroups, respectively. Magnetic resonance imaging tissue phase mapping was employed to evaluate the voxelwise biventricular myocardial motion in longitudinal (Vz), radial (Vr), and circumferential (Vφ) directions. Results The rTOFlow subgroup presented higher pulmonary regurgitation fraction than rTOFhigh subgroup (p < 0.001). Compared with the normal group, only rTOFlow subgroup presented a decreased RV ejection fraction (RVEF) (p < 0.05). The rTOFlow subgroup showed decreased systolic and diastolic Vz in RV and LV, whereas rTOFhigh subgroup showed such change only in RV. In rTOFlow subgroup, RVEF significantly correlated with RV systolic Vr (r = 0.56, p < 0.05), whereas LVEF correlated with LV systolic Vz (r = 0.51, p = 0.02). Prolonged QRS correlated with RV systolic Vr (r = -0.58, p < 0.01) and LV diastolic Vr (r = 0.81, p < 0.001). No such correlations occurred in rTOFhigh subgroup. Conclusions The avoidance of unfavorable functional interaction in RV and LV in rTOFhigh subgroup suggested that adequate pulmonary stenosis (PGRVPA ? 15 mmHg in this sereis) has a protective effect against pulmonary regurgitation. ? 2020 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
adaptation; adult; age; Article; biventricular myocardial adaptation; blood pressure measurement; cardiac patient; clinical article; controlled study; diagnostic accuracy; diagnostic test accuracy study; diastolic blood pressure; disease association; disease classification; disease severity; Fallot tetralogy; female; functional assessment; heart catheterization; heart function; heart left ventricle ejection fraction; heart left ventricle pressure; heart right ventricle ejection fraction; heart right ventricle pressure; heart ventricle remodeling; human; lung artery pressure; male; nuclear magnetic resonance imaging; pressure gradient; pulmonary valve insufficiency; pulmonary valve stenosis; QRS interval; receiver operating characteristic; reference value; sex factor; systolic blood pressure; young adult; blood pressure; case control study; diagnostic imaging; exercise test; Fallot tetralogy; heart left ventricle function; heart rate; heart right ventricle function; heart stroke volume; nuclear magnetic resonance imaging; pathophysiology; procedures; pulmonary valve insufficiency; pulmonary valve stenosis; Adult; Blood Pressure; Case-Control Studies; Exercise Test; Female; Heart Rate; Humans; Magnetic Resonance Imaging; Male; Pulmonary Valve Insufficiency; Pulmonary Valve Stenosis; Stroke Volume; Tetralogy of Fallot; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Ventricular Function, Left; Ventricular Function, Right; Young Adult
Type
journal article