Abstract
ObjectivesTo investigate to what extent cardiac MRI derived measurements of right ventricular (RV) volumes using the left ventricular (LV) end-systolic and end-diastolic frame misrepresent RV end-systolic and end-diastolic volumes in patients with tetralogy of Fallot (ToF) and a right bundle branch block.MethodsSixty-five cardiac MRI scans of patients with ToF and a right bundle branch block, and 50 cardiac MRI scans of control subjects were analyzed. RV volumes and function using the end-systolic and end-diastolic frame of the RV were compared to using the end-systolic and end-diastolic frame of the LV.ResultsTiming of the RV end-systolic frame was delayed compared to the LV end-systolic frame in 94% of patients with ToF and in 50% of control subjects. RV end-systolic volume using the RV end-systolic instead of LV end-systolic frame was smaller in ToF (median −3.3 ml/m2, interquartile range −1.9 to −5.6 ml/m2; p<0.001) and close to unchanged in control subjects. Using the RV instead of LV end-systolic and end-diastolic frame hardly affected RV end-diastolic volumes in both groups and ejection fraction in control subjects (54±4%, both methods), while increasing ejection fraction from 45±7% to 48±7% for patients with ToF (p<0.001). QRS duration correlated positively with the changes in the RV end-systolic volume (p<0.001) and RV ejection fraction obtained in ToF patients when using the RV instead of the LV end-systolic and end-diastolic frame (p = 0.004).ConclusionFor clinical decision making in ToF patients RV volumes derived from cardiac MRI should be measured in the end-systolic frame of the RV instead of the LV.
Highlights
Evaluation of right ventricular (RV) volumes and function is crucial in the management of patients with congenital heart disease [1,2]
QRS duration was longer in patients with tetralogy of Fallot (ToF) (145625 ms) than in control subjects (9369 ms), p,0.001
In almost all patients with ToF and half of control subjects the end-systolic frame of the RV was delayed compared to the left ventricle (LV)
Summary
Evaluation of right ventricular (RV) volumes and function is crucial in the management of patients with congenital heart disease [1,2]. Cardiac magnetic resonance (CMR) imaging is the golden standard in the evaluation of RV volume and function, and plays an important role in the decision for pulmonary valve replacement in patients with ToF and pulmonary regurgitation [1,2,3,4,5,6,7]. To acquire accurate CMR derived volume measurements, correct selection of the RV end-systolic and end-diastolic frame may be important. Most patients with ToF have a right bundle branch block (RBBB) which leads to intra- and interventricular dyssynchrony. This dyssynchrony significantly extends duration of RV contraction and delays timing of RV end-systole compared to the LV [7,9,10]. Others state that independent selection of the RV frame is unnecessary as the magnitude of the misrepresentation of RV volumes and function is too small to be of clinical importance
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