PMID- 35839154
OWN - NLM
STAT- MEDLINE
DCOM- 20220823
LR  - 20240216
IS  - 1522-1539 (Electronic)
IS  - 0363-6135 (Print)
IS  - 0363-6135 (Linking)
VI  - 323
IP  - 3
DP  - 2022 Sep 1
TI  - Statistical shape modeling reveals the link between right ventricular shape, 
      hemodynamic force, and myocardial function in patients with repaired tetralogy of 
      Fallot.
PG  - H449-H460
LID - 10.1152/ajpheart.00228.2022 [doi]
AB  - Patients with repaired tetralogy of Fallot (rTOF) can develop chronic pulmonary 
      insufficiency (PI) with right ventricular (RV) dilation, progressive RV 
      dysfunction, and decreased exercise capacity. Pulmonary valve replacement (PVR) 
      can help reduce the amount of PI and RV dilation; however, optimal timing remains 
      controversial; a better understanding of rTOF pathophysiology is of fundamental 
      importance to inform clinical management of patients with rTOF and optimal timing 
      of PVR. In this study, we hypothesize a tight interplay between RV shape, 
      intracardiac biomechanics, and ventricular function in patients with rTOF. To 
      explore this hypothesis and derive quantitative measures, we combined statistical 
      shape modeling with physics-based analysis of in vivo 4D flow data in 36 patients 
      with rTOF. Our study demonstrated for the first time a correlation between 
      regional RV shape variations, hemodynamic forces (HDF), and clinical dysfunction 
      in patients with rTOF. The main findings of this work include 1) general increase 
      in RV size, due to both volume overload and physiological growth, correlated with 
      decrease in strain magnitude in the respective directions, and with increased 
      QRS; 2) regional PI-induced remodeling accounted for  approximately 10% of the shape 
      variability of the population, and was associated with increased diastolic HDF 
      along the diaphragm-to-right ventricular outflow tract (RVOT) direction, 
      resulting in a net RV deformation along the same direction and decreased 
      tricuspid annular plane systolic excursion (TAPSE); and 3) three shape modes 
      independently correlated with systolic HDF and exercise capacity. Identification 
      of patients based on the shape variations described in this study could help 
      identify those at risk for irreversible dysfunction and guide optimal timing of 
      PVR.NEW & NOTEWORTHY We combine statistical shape modeling with physics-based 
      analysis of 4D flow data to elucidate the interplay between RV shape, hemodynamic 
      forces, and clinical dysfunction in repaired tetralogy of Fallot. We are the 
      first to show that ventricular remodeling is related to hemodynamic force 
      magnitude and direction, global and regional functional parameters, and exercise 
      intolerance. Identification of patients based on the shape variations described 
      in this study could help identify those at risk for irreversible dysfunction.
FAU - Kollar, Sarah
AU  - Kollar S
AUID- ORCID: 0000-0002-3036-7407
AD  - Division of Cardiology, Children's National Medical Center, Washington, District 
      of Columbia.
FAU - Balaras, Elias
AU  - Balaras E
AD  - Department of Mechanical and Aerospace Engineering, George Washington University, 
      Washington, District of Columbia.
FAU - Olivieri, Laura J
AU  - Olivieri LJ
AD  - Division of Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, 
      Pennsylvania.
FAU - Loke, Yue-Hin
AU  - Loke YH
AD  - Division of Cardiology, Children's National Medical Center, Washington, District 
      of Columbia.
FAU - Capuano, Francesco
AU  - Capuano F
AUID- ORCID: 0000-0003-0274-5260
AD  - Department of Fluid Mechanics, Universitat Politecnica de 
      Catalunya-BarcelonaTech, Barcelona, Spain.
LA  - eng
GR  - R01 HL143468/HL/NHLBI NIH HHS/United States
GR  - R21 HL156045/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20220715
PL  - United States
TA  - Am J Physiol Heart Circ Physiol
JT  - American journal of physiology. Heart and circulatory physiology
JID - 100901228
SB  - IM
MH  - Heart Ventricles
MH  - Hemodynamics
MH  - Humans
MH  - *Pulmonary Valve Insufficiency/diagnostic imaging/etiology/surgery
MH  - *Tetralogy of Fallot/surgery
MH  - *Ventricular Dysfunction, Right/complications/etiology
MH  - Ventricular Function, Right/physiology
PMC - PMC9394773
OTO - NOTNLM
OT  - hemodynamic forces
OT  - statistical shape modeling
OT  - tetralogy of Fallot
OT  - ventricular remodeling
COIS- No conflicts of interest, financial or otherwise, are declared by the authors.
EDAT- 2022/07/16 06:00
MHDA- 2022/08/24 06:00
PMCR- 2023/09/01
CRDT- 2022/07/15 13:23
PHST- 2022/07/16 06:00 [pubmed]
PHST- 2022/08/24 06:00 [medline]
PHST- 2022/07/15 13:23 [entrez]
PHST- 2023/09/01 00:00 [pmc-release]
AID - H-00228-2022 [pii]
AID - 10.1152/ajpheart.00228.2022 [doi]
PST - ppublish
SO  - Am J Physiol Heart Circ Physiol. 2022 Sep 1;323(3):H449-H460. doi: 
      10.1152/ajpheart.00228.2022. Epub 2022 Jul 15.