Abstract
BackgroundRight ventricular ejection fraction (RV-EF) has traditionally been used to measure and compare RV function serially over time, but may be a relatively insensitive marker of change in RV myocardial contractile function. We developed a cardiovascular magnetic resonance (CMR) tagging-based technique with a view to rapid and reproducible measurement of RV long axis function and applied it in patients with congenital heart disease.MethodsWe studied 84 patients: 56 with repaired Tetralogy of Fallot (rTOF); 28 with atrial septal defect (ASD): 13 with and 15 without pulmonary hypertension (RV pressure > 40 mmHG by echocardiography). For comparison, 20 healthy controls were studied. CMR acquisitions included an anatomically defined four chamber cine followed by a cine gradient echo-planar sequence in the same plane with a labelling pre-pulse giving a tag line across the basal myocardium. RV tag displacement was measured with automated registration and tracking of the tag line together with standard measurement of RV-EF.ResultsMean RV displacement was higher in the control (26 ± 3 mm) than in rTOF (16 ± 4 mm) and ASD with pulmonary hypertension (18 ± 3 mm) groups, but lower than in the ASD group without (30 ± 4 mm), P < 0.001. The technique was reproducible with inter-study bias ± 95% limits of agreement of 0.7 ± 2.7 mm. While RV-EF was lower in rTOF than in controls (49 ± 9% versus 57 ± 6%, P < 0.001), it did not differ between either ASD group and controls.ConclusionsMeasurements of RV long axis displacement by CMR tagging showed more differences between the groups studied than did RV-EF, and was reproducible, quick and easy to apply. Further work is needed to assess its potential use for the detection of longitudinal changes in RV myocardial function.
Highlights
Right ventricular ejection fraction (RV-EF) has traditionally been used to measure and compare RV function serially over time, but may be a relatively insensitive marker of change in RV myocardial contractile function
The assessment of RV function is important in the setting of congenital heart disease where detecting deterioration of RV function by cardiovascular magnetic resonance (CMR) may be considered an indication for operative intervention [1,2]
Study population Eighty four patients undergoing clinical CMR at Royal Brompton Hospital with either previously repaired tetralogy of Fallot with pulmonary regurgitation (PR) (n = 56), or unoperated atrial septal defect (ASD) with pulmonary hypertension (PHT) (n = 13) or without PHT (n = 15) were recruited prospectively, PHT being defined as an estimated RV systolic pressure > 40 mmHg derived from the peak tricuspid regurgitant jet velocity plus right atrial pressure estimated on echocardiography [6]
Summary
Right ventricular ejection fraction (RV-EF) has traditionally been used to measure and compare RV function serially over time, but may be a relatively insensitive marker of change in RV myocardial contractile function. We developed a cardiovascular magnetic resonance (CMR) tagging-based technique with a view to rapid and reproducible measurement of RV long axis function and applied it in patients with congenital heart disease. The assessment of RV function is important in the setting of congenital heart disease where detecting deterioration of RV function by cardiovascular magnetic resonance (CMR) may be considered an indication for operative intervention [1,2]. A linear tag was oriented perpendicular to the basal free wall, allowing a simple automated measurement of its apically directed displacement. We hypothesized that this technique would be reproducible and could differentiate between populations with normal RVs and those with pressure and/or volume loading
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