Dataset Information

Pulmonary regurgitant volume is superior to fraction using background-corrected phase contrast MRI in determining the severity of regurgitation in repaired tetralogy of Fallot.

ABSTRACT: In the assessment of pulmonary regurgitation (PR) using phase contrast MRI, phase offset errors affect the accuracy of flow. This study evaluated the use of automated background correction for phase offset in the quantification of PR fraction and volume in patients with repaired tetralogy of Fallot (TOF), and to assess its clinical impact. We retrospectively analyzed 203 cardiac MRI studies, performed on 1.5-T scanner. Pulmonary flow (Q(P)) and systemic flow (Q(S)) was assessed both with and without background correction. Non-corrected and corrected Q(P) was correlated with Q(S). PR was correlated with (1) indexed right ventricular end-diastolic volume (RVEDVi) and (2) with differential right and left ventricular stroke volumes (PR(SV)). Both PR fraction and volume showed major change after correction (-43 to +36% and -13 to +13 ml/m(2)). Corrected Q(P) and Q(S) were stronger correlated with each other than non-corrected Q(P) and Q(S) [r = 0.78 vs. 0.73 (p < 0.001)]. Both PR fraction and volume were stronger correlated with RVEDVi, compared to their non-corrected counterparts (p < 0.001). PR volume was stronger correlated with RVEDVi, compared to PR fraction [r = 0.74 vs. 0.69 (p < 0.001)]. When patients were divided according to PR severity, 12% of patients reclassified after correction. Background correction for phase offset significantly changed the quantification of PR. Non-corrected assessment of PR may result in the misclassification of patients. Our data suggest that the use of PR volume is favourable in the follow-up of patients with repaired TOF.

SUBMITTER: Gorter TM

PROVIDER: S-EPMC4486784 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Pulmonary regurgitant volume is superior to fraction using background-corrected phase contrast MRI in determining the severity of regurgitation in repaired tetralogy of Fallot.

Gorter Thomas M TM van Melle Joost P JP Freling Hendrik G HG Ebels Tjark T Bartelds Beatrijs B Pieper Petronella G PG Berger Rolf M F RM van Veldhuisen Dirk J DJ Willems Tineke P TP

The international journal of cardiovascular imaging 20150506 6

In the assessment of pulmonary regurgitation (PR) using phase contrast MRI, phase offset errors affect the accuracy of flow. This study evaluated the use of automated background correction for phase offset in the quantification of PR fraction and volume in patients with repaired tetralogy of Fallot (TOF), and to assess its clinical impact. We retrospectively analyzed 203 cardiac MRI studies, performed on 1.5-T scanner. Pulmonary flow (Q(P)) and systemic flow (Q(S)) was assessed both with and wit ...[more]

PMID: 25944487

Similar Datasets

Project description:Background and purposeElectromechanical dyssynchrony, manifested by right bundle branch block and regional wall mechanical dysfunction, contributes to inefficient RV function in repaired Tetralogy of Fallot (ToF). This study aims to evaluate the synchronicity of multiple RV walls using two-dimensional multi-plane echocardiography (2D-MPE) in order to augment current understanding of the mechanisms behind RV dyssynchrony.MethodsSixty-nine adult ToF patients [aged 33 (23-45) years; 61% male] and twenty-five matched healthy controls underwent deformational analysis of the RV lateral, anterior, inferior and septal walls following 2D-MPE acquisitions. RV synchronicity was assessed by the intra-RV deformation delay between each basal RV wall and mid-septal segment in addition to mechanical dispersion calculated across four, six and eight segments (MD).ResultsAll RV wall-septum delays plus MD-4 and MD-6 indices were significantly greater in ToF patients compared to healthy controls (p < 0.001-0.03). In ToF patients, the lateral and anterior RV walls were last to reach peak deformation and anterior wall longitudinal strain was lower (p = 0.001). Post systolic shortening of at least one RV wall segment was identified in 19 (28%) ToF patients. Despite similar ECG characteristics, lateral and anterior wall-septum delays were significantly longer in patients with greater degrees of dyssynchrony (73 [37-108]ms vs. 37 [0-63]ms, p = 0.006; 91 [52-116]ms vs. 41 [1-69]ms, p = 0.013), although RV ejection fraction (RVEF) was not significantly lower. MD-4 and MD-8 indices displayed moderate negative associations with RVEF, strengthened by inclusion of lateral wall longitudinal strain (r = 0.64/0.65; p ≤0.01).ConclusionRV dyssynchrony in ToF is characterised by electromechanical delays between the lateral, anterior and septal walls, with anterior wall dysfunction likely associated with surgical repair of the RV outflow tract. Prospectively, 2D-MPE may have an emerging role evaluating RV mechanical response to electrical resynchronisation therapy.

Project description:Background and objectiveThe effect of chronic pulmonary regurgitation (PR) on right ventricular (RV) dysfunction in repaired Tetralogy of Fallot (RTOF) patients is well recognized by cardiac magnetic resonance (CMR). However, the link between RV wall motion, intracardiac flow and PR has not been established. Hemodynamic force (HDF) represents the global force exchanged between intracardiac blood volume and endocardium, measurable by 4D flow or by a novel mathematical model of wall motion. In our study, we used this novel methodology to derive HDF in a cohort of RTOF patients, exclusively using routine CMR imaging.MethodsRTOF patients and controls with CMR imaging were retrospectively included. Three-dimensional (3D) models of RV were segmented, including RV outflow tract (RVOT). Feature-tracking software (QStrain 2.0, Medis Medical Imaging Systems, Leiden, Netherlands) captured endocardial contours from long/short-axis cine and used to reconstruct RV wall motion. A global HDF vector was computed from the moving surface, then decomposed into amplitude/impulse of three directional components based on reference (Apical-to-Basal, Septal-to-Free Wall and Diaphragm-to-RVOT direction). HDF were compared and correlated against CMR and exercise stress test parameters. A subset of RTOF patients had 4D flow that was used to derive vorticity (for correlation) and HDF (for comparison against cine method).Results68 RTOF patients and 20 controls were included. RTOF patients had increased diastolic HDF amplitude in all three directions (p<0.05). PR% correlated with Diaphragm-RVOT HDF amplitude/impulse (r = 0.578, p<0.0001, r = 0.508, p < 0.0001, respectively). RV ejection fraction modestly correlated with global HDF amplitude (r = 0.2916, p = 0.031). VO2-max correlated with Septal-to-Free Wall HDF impulse (r = 0.536, p = 0.007). Diaphragm-to-RVOT HDF correlated with RVOT vorticity (r = 0.4997, p = 0.001). There was no significant measurement bias between Cine-derived HDF and 4D flow-derived HDF by Bland-Altman analysis.ConclusionRTOF patients have abnormal diastolic HDF that is correlated to PR, RV function, exercise capacity and vorticity. HDF can be derived from conventional cine, and is a potential link between RV wall motion and intracardiac flow from PR in RTOF patients.

Dataset Information

Pulmonary regurgitant volume is superior to fraction using background-corrected phase contrast MRI in determining the severity of regurgitation in repaired tetralogy of Fallot.

Publications

Pulmonary regurgitant volume is superior to fraction using background-corrected phase contrast MRI in determining the severity of regurgitation in repaired tetralogy of Fallot.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets