PMID- 36822439
OWN - NLM
STAT- MEDLINE
DCOM- 20230605
LR  - 20230610
IS  - 1097-6795 (Electronic)
IS  - 0894-7317 (Print)
IS  - 0894-7317 (Linking)
VI  - 36
IP  - 6
DP  - 2023 Jun
TI  - Intracardiac Flow Analysis of the Right Ventricle in Pediatric Patients With 
      Repaired Tetralogy of Fallot Using a Novel Color Doppler Velocity Reconstruction.
PG  - 644-653
LID - S0894-7317(23)00092-5 [pii]
LID - 10.1016/j.echo.2023.02.008 [doi]
AB  - BACKGROUND: Repaired tetralogy of Fallot (RTOF) patients will develop right 
      ventricular (RV) dysfunction from chronic pulmonary regurgitation (PR). Cardiac 
      magnetic resonance sequences such as four-dimensional flow can demonstrate 
      altered vorticity and flow energy loss (FEL); however, they are not as available 
      as conventional echocardiography (echo). The study determined whether a novel, 
      vendor-independent Doppler velocity reconstruction (DoVeR) could measure RV 
      intracardiac flow in conventional echo of RTOF patients. The primary hypothesis 
      was that DoVeR could detect increased vorticity and diastolic FEL in RTOF 
      patients. METHODS: Repaired tetralogy of Fallot patients with echo were 
      retrospectively paired with age-/size-matched controls. Doppler velocity 
      reconstruction employed the stream function-vorticity equation to approximate 
      intracardiac flow fields from color Doppler. A velocity field of the right 
      ventricle was reconstructed from the apical 4-chamber view. Vortex strength (VS, 
      area integral of vorticity) and FEL were derived from DoVeR. Cardiac magnetic 
      resonance and exercise stress parameters (performed within 1 year of echo) were 
      collected for analysis. RESULTS: Twenty RTOF patients and age-matched controls 
      were included in the study. Mean regurgitant fraction was 40.5% +/- 7.6%, and 
      indexed RV end-diastolic volume was 158 +/- 36 mL/m(2). Repaired tetralogy of 
      Fallot patients had higher total, mean diastolic, and peak diastolic VS 
      (P = .0013, P = .0012, P = .0032, respectively) and higher total, mean diastolic, 
      and peak diastolic body surface area-indexed FEL (P = .0016, P = .0022, P < .001, 
      respectively). Peak diastolic indexed FEL and peak diastolic VS had 
      weak-to-moderate negative correlation with RV ejection fraction (r = -0.52 
      [P = .019] and r = -0.49 [P = .030], respectively) and left ventricular ejection 
      fraction (r = -0.47 [P = .034] and r = -0.64 [P = .002], respectively). Mean 
      diastolic indexed FEL and VS had moderate-to-strong negative correlation with 
      percent predicted maximal oxygen consumption (r = -0.69 [P = .012] and r = -0.75 
      [P = .006], respectively). CONCLUSIONS: DoVeR can detect alterations to 
      intracardiac flow in RTOF patients from conventional color Doppler imaging. 
      Echo-based measures of diastolic VS and FEL correlated with ventricular function. 
      DoVeR has the potential to provide serial evaluation of abnormal flow dynamics in 
      RTOF patients.
CI  - Copyright (c) 2023 American Society of Echocardiography. Published by Elsevier Inc. 
      All rights reserved.
FAU - Meyers, Brett
AU  - Meyers B
AD  - School of Mechanical Engineering, Purdue University, West Lafayette, Indiana.
FAU - Nyce, Jonathan
AU  - Nyce J
AD  - Department of Cardiology, Children's National Hospital, Washington, D.C.
FAU - Zhang, Jiacheng
AU  - Zhang J
AD  - School of Mechanical Engineering, Purdue University, West Lafayette, Indiana.
FAU - Frank, Lowell H
AU  - Frank LH
AD  - Department of Cardiology, Children's National Hospital, Washington, D.C.
FAU - Balaras, Elias
AU  - Balaras E
AD  - School of Engineering & Applied Science, George Washington University, 
      Washington, D.C.
FAU - Vlachos, Pavlos P
AU  - Vlachos PP
AD  - School of Mechanical Engineering, Purdue University, West Lafayette, Indiana.
FAU - Loke, Yue-Hin
AU  - Loke YH
AD  - Department of Cardiology, Children's National Hospital, Washington, D.C.. 
      Electronic address: yloke@childrensnational.org.
LA  - eng
GR  - R21 HL156045/HL/NHLBI NIH HHS/United States
GR  - R01 HL143468/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20230221
PL  - United States
TA  - J Am Soc Echocardiogr
JT  - Journal of the American Society of Echocardiography : official publication of the 
      American Society of Echocardiography
JID - 8801388
SB  - IM
MH  - Humans
MH  - Child
MH  - Heart Ventricles/diagnostic imaging
MH  - *Tetralogy of Fallot/diagnosis/surgery
MH  - Stroke Volume
MH  - Retrospective Studies
MH  - Ventricular Function, Left
MH  - *Ventricular Dysfunction, Right
MH  - Ventricular Function, Right
MH  - *Pulmonary Valve Insufficiency
PMC - PMC10247486
MID - NIHMS1877878
OTO - NOTNLM
OT  - Congenital heart disease
OT  - Doppler velocity reconstruction
OT  - Energy loss
OT  - Tetralogy of Fallot
OT  - Vorticity
EDAT- 2023/02/24 06:00
MHDA- 2023/06/05 06:42
PMCR- 2024/06/01
CRDT- 2023/02/23 19:33
PHST- 2022/12/05 00:00 [received]
PHST- 2023/02/08 00:00 [revised]
PHST- 2023/02/10 00:00 [accepted]
PHST- 2024/06/01 00:00 [pmc-release]
PHST- 2023/06/05 06:42 [medline]
PHST- 2023/02/24 06:00 [pubmed]
PHST- 2023/02/23 19:33 [entrez]
AID - S0894-7317(23)00092-5 [pii]
AID - 10.1016/j.echo.2023.02.008 [doi]
PST - ppublish
SO  - J Am Soc Echocardiogr. 2023 Jun;36(6):644-653. doi: 10.1016/j.echo.2023.02.008. 
      Epub 2023 Feb 21.