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Transverse strain predicts exercise capacity in systemic right ventricle patients.
MedLine Citation:
PMID:  19481823     Owner:  NLM     Status:  In-Process    
BACKGROUND: Because transposition of great arteries (TGA) patients who underwent atrial switch repair (AS) remain asymptomatic for decades before development of symptomatic heart failure, there may be some clinical value to preclinical detection of ventricular dysfunction. Detection of systemic right ventricular (RV) dysfunction in patients who are asymptomatic may prompt early initiation of heart failure therapy and more frequent clinical follow-up.
AIM: The objective of this study was to characterize longitudinal and transverse systolic function of the systemic RV using two-dimensional (2D) strain in patients with TGA after AS repair and to correlate these parameters with their exercise capacity.
METHODS: The study population consisted of 26 patients (20±6 years) with TGA after AS operation. Conventional echocardiography and bidimensional strain were performed on consecutive patients reporting to the out patient congenital heart disease clinic. Twenty-four healthy, age-matched individuals were used as control subjects. Analysis was performed on the non-systemic RVs of the control group. All the studied patients underwent treadmill exercise testing according to the Bruce II protocol.
RESULTS: RV longitudinal 2D-strain in controls showed a base to apex gradient, while in patients was homogeneously reduced. Also RV transverse strain (i.e the radial deformation assessed by the apical 4 chamber view) showed a base to apex gradient in controls, while in patients was significantly increased in the mid and apical segments. In the systemic RV free wall, transverse strain was greater than longitudinal strain (p<0.0001), opposite from findings in the normal RV free wall (p: NS). Of interest, in AS-TGA patients we found a strong correlation between RV transverse 2D strain and exercise capacity (p<0.0001; R: 0.80). At multivariate analysis (including age, degree of tricuspid regurgitation, TAPSE, RV area fractional change, RV visually estimated ejection fraction, RV global longitudinal strain and RV global transverse strain) the best predictor of exercise capacity in AS-TGA patients was transverse 2D strain (p<0.0001).
CONCLUSIONS: In AS-TGA patients there is a shift from a predominant longitudinal shortening to a predominant transverse thickening. The transverse thickening assessed by 2D transverse strain is correlated to exercise capacity of these patients. In the follow up of AS-TGA patients the monitoring of RV transverse myocardial deformation properties should be considered more than the simple evaluation of RV longitudinal function.
Giovanni Di Salvo; Giuseppe Pacileo; Alessandra Rea; Giuseppe Limongelli; Luca Baldini; Antonello D'Andrea; Michele D'Alto; Berardo Sarubbi; Maria Giovanna Russo; Raffaele Calabrò
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Publication Detail:
Type:  Journal Article     Date:  2009-05-29
Journal Detail:
Title:  International journal of cardiology     Volume:  145     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-12-07     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  193-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.
Second University of Naples, Chair of Cardiology, Pediatric Cardiology, Monaldi Hospital, Italy.
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