PMID- 34412634
OWN - NLM
STAT- MEDLINE
DCOM- 20211028
LR  - 20240117
IS  - 1532-429X (Electronic)
IS  - 1097-6647 (Print)
IS  - 1097-6647 (Linking)
VI  - 23
IP  - 1
DP  - 2021 Aug 19
TI  - Moving beyond size: vorticity and energy loss are correlated with right 
      ventricular dysfunction and exercise intolerance in repaired Tetralogy of Fallot.
PG  - 98
LID - 10.1186/s12968-021-00789-2 [doi]
LID - 98
AB  - BACKGROUND: The global effect of chronic pulmonary regurgitation (PR) on right 
      ventricular (RV) dilation and dysfunction in repaired Tetralogy of Fallot (rTOF) 
      patients is well studied by cardiovascular magnetic resonance (CMR). However, the 
      links between PR in the RV outflow tract (RVOT), RV dysfunction and exercise 
      intolerance are not clarified by conventional measurements. Not all patients with 
      RV dilation share the same intracardiac flow characteristics, now measurable by 
      time resolved three-dimensional phase contrast imaging (4D flow). In our study, 
      we quantified regional vorticity and energy loss in rTOF patients and correlated 
      these parameters with RV dysfunction and exercise capacity. METHODS: rTOF 
      patients with 4D flow datasets were retrospectively analyzed, including those 
      with transannular/infundibular repair and conduit repair. Normal controls and RV 
      dilation patients with atrial-level shunts (Qp:Qs > 1.2:1) were included for 
      comparison. 4D flow was post-processed using IT Flow (Cardioflow, Japan). 
      Systolic/diastolic vorticity (omega, 1/s) and viscous energy loss (VEL, mW) in the 
      RVOT and RV inflow were measured. To characterize the relative influence of 
      diastolic vorticity in the two regions, an RV Diastolic Vorticity Quotient 
      (omega(RVOT-Diastole)/omega(RV Inflow-Diastole,) RV-DVQ) was calculated. Additionally, 
      RVOT Vorticity Quotient (omega(RVOT-Diastole)/omega(RVOT-Systole), RVOT-VQ) and RVOT 
      Energy Quotient (VEL(RVOT-Diastole)/VEL(RVOT-Systole), RVOT-EQ) was calculated. 
      In rTOF, measurements were correlated against conventional CMR and exercise 
      stress test results. RESULTS: 58 rTOF patients, 28 RV dilation patients and 12 
      controls were included. RV-DVQ, RVOT-VQ, and RVOT-EQ were highest in rTOF 
      patients with severe PR compared to rTOF patients with non-severe PR, RV dilation 
      and controls (p < 0.001). RV-DVQ positively correlated with RV end-diastolic 
      volume (0.683, p < 0.001), PR fraction (0.774, p < 0.001) and negatively with RV 
      ejection fraction (- 0.521, p = 0.003). Both RVOT-VQ, RVOT-EQ negatively 
      correlated with VO(2-max) (- 0.587, p = 0.008 and - 0.617, p = 0.005) and % 
      predicted VO(2-max) (- 0.678, p = 0.016 and - 0.690, p = 0.001). CONCLUSIONS: In 
      rTOF patients, vorticity and energy loss dominate the RVOT compared to tricuspid 
      inflow, correlating with RV dysfunction and exercise intolerance. These 4D 
      flow-based measurements may be sensitive biomarkers to guide surgical management 
      of rTOF patients.
CI  - (c) 2021. The Author(s).
FAU - Loke, Yue-Hin
AU  - Loke YH
AUID- ORCID: 0000-0003-1003-1903
AD  - Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, 
      W3-200, Washington, DC, 20010, USA. yloke@childrensnational.org.
FAU - Capuano, Francesco
AU  - Capuano F
AD  - Department of Mechanics, Mathematics and Management, Polytechnic University of 
      Bari, Bari, Italy.
FAU - Cleveland, Vincent
AU  - Cleveland V
AD  - Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National 
      Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA.
FAU - Mandell, Jason G
AU  - Mandell JG
AD  - Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, 
      W3-200, Washington, DC, 20010, USA.
FAU - Balaras, Elias
AU  - Balaras E
AD  - Department of Mechanical and Aerospace Engineering, George Washington University, 
      Washington, DC, 20052, USA.
FAU - Olivieri, Laura J
AU  - Olivieri LJ
AD  - Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, 
      W3-200, Washington, DC, 20010, USA.
AD  - Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National 
      Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA.
LA  - eng
GR  - R01 HL143468/HL/NHLBI NIH HHS/United States
GR  - R21 HL156045/HL/NHLBI NIH HHS/United States
GR  - UL1 TR001876/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20210819
PL  - England
TA  - J Cardiovasc Magn Reson
JT  - Journal of cardiovascular magnetic resonance : official journal of the Society 
      for Cardiovascular Magnetic Resonance
JID - 9815616
SB  - IM
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Predictive Value of Tests
MH  - *Pulmonary Valve Insufficiency
MH  - Retrospective Studies
MH  - *Tetralogy of Fallot/diagnostic imaging/surgery
MH  - *Ventricular Dysfunction, Right/diagnostic imaging/etiology
MH  - Ventricular Function, Right
PMC - PMC8377822
OTO - NOTNLM
OT  - 4D flow
OT  - Intracardiac flow
OT  - Tetralogy of Fallot
OT  - Vorticity
COIS- The authors declare they have no competing interests.
EDAT- 2021/08/21 06:00
MHDA- 2021/10/29 06:00
PMCR- 2021/08/19
CRDT- 2021/08/20 05:39
PHST- 2021/03/16 00:00 [received]
PHST- 2021/06/28 00:00 [accepted]
PHST- 2021/08/20 05:39 [entrez]
PHST- 2021/08/21 06:00 [pubmed]
PHST- 2021/10/29 06:00 [medline]
PHST- 2021/08/19 00:00 [pmc-release]
AID - S1097-6647(23)00439-8 [pii]
AID - 789 [pii]
AID - 10.1186/s12968-021-00789-2 [doi]
PST - epublish
SO  - J Cardiovasc Magn Reson. 2021 Aug 19;23(1):98. doi: 10.1186/s12968-021-00789-2.