Document Detail

Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot.
MedLine Citation:
PMID:  19255342     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The underlying mechanisms that contribute to global right ventricular (RV) dysfunction in patients with repaired tetralogy of Fallot are incompletely understood. We therefore sought to quantify regional RV abnormalities and to determine the relationship of these to global RV function and exercise capacity. METHODS AND RESULTS: Clinical and cardiac magnetic resonance data from 62 consecutive patients with repaired tetralogy of Fallot were analyzed (median age at follow-up 23 years [limits 9 to 67 years]). Using cardiac magnetic resonance data, 3D RV endocardial surface models were reconstructed from segmented contours, and a correspondence between end diastole and end systole was computed with a novel algorithm. Regional RV abnormalities were quantified and expressed as segmental ejection fraction, spatial extent of dyskinetic area, displacement of dyskinetic area, and score of extent of late gadolinium enhancement. Regional abnormalities of function and hyperenhancement were greatest in the RV outflow tract (RVOT). These regional RVOT abnormalities correlated with global RV ejection fraction: RVOT ejection fraction r=0.64, P<0.0001; RVOT dyskinetic area r=-0.51, P<0.0001; RVOT displacement of dyskinetic area r=-0.49, P<0.0001; and RVOT late gadolinium enhancement score r=-0.33, P=0.01. Peak oxygen consumption during exercise correlated best with RVOT ejection fraction (r=0.56, P=0.0002) compared with the remainder of the RV (r=0.35, P=0.03). The only cardiac magnetic resonance variable independently predictive of aerobic capacity was RVOT ejection fraction (P=0.02). CONCLUSIONS: A greater extent of regional abnormalities in the RVOT adversely affects global RV function and exercise capacity after tetralogy of Fallot repair. These regional measures may have important implications for patient management, including RVOT reconstruction, at the time of pulmonary valve replacement.
Rachel M Wald; Idith Haber; Ron Wald; Anne Marie Valente; Andrew J Powell; Tal Geva
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2009-03-02
Journal Detail:
Title:  Circulation     Volume:  119     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-17     Completed Date:  2009-04-16     Revised Date:  2010-09-22    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1370-7     Citation Subset:  AIM; IM    
Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
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MeSH Terms
Contrast Media*
Exercise Tolerance*
Gadolinium / diagnostic use*
Heart Failure / etiology,  physiopathology
Imaging, Three-Dimensional
Magnetic Resonance Imaging*
Middle Aged
Pulmonary Valve / surgery
Single-Blind Method
Stroke Volume
Tachycardia, Ventricular / etiology,  physiopathology
Tetralogy of Fallot / physiopathology,  surgery*
Ventricular Dysfunction, Right / etiology*,  radionuclide imaging
Young Adult
Grant Support
1P50 HL074734-01/HL/NHLBI NIH HHS; P50 HL074734-010002/HL/NHLBI NIH HHS
Reg. No./Substance:
0/Contrast Media; 7440-54-2/Gadolinium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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