Abstract 19955: Left Ventricular Global Systemic Strain is Reduced in Adults with Tetralogy of Fallot, Relates to Right Ventricular Enlargement and Predicts Adverse Clinical Outcome
Background: Pulmonary regurgitation and right ventricular dysfunction are common sequelae after repair of Tetralogy of Fallot (ToF) and, in turn, affect left ventricle (LV) shape and function. Recent studies suggest that left ventricular ejection fraction (EF) may be of prognostic value in this setting. As sensitivity of EF in detecting early ventricular dysfunction is limited and most ToF patients present with normal LV, we aimed to assess the value of novel indices of myocardial deformation on speckle-tracking echocardiography for quantifying LV function, and their potential role in assessing clinical outcome.
Methods and Results: 135 ToF patients (74 male, age 36±16 years) were investigated and compared to 38 age and gender matched controls. LV longitudinal (2D-LS) and radial 2D-peak systolic strain (2D-RS) were significantly reduced compared to controls (−16.6±4.8 vs. −18.9±3.4, p=0.004 and −21.8±10.1 vs. −40.2±5.6, p<0.0001 for LS and RS, respectively). Both, 2D-LS (r=−0.62) and 2D-RS (r=−0.40) correlated with LV EF (p<0.0001). In addition, 2D-LS and 2D-RS were related to right ventricular dimensions (RV enddiastolic and endsystolic dimensions and area, p<0.05 for each) and function (RV fractional area change, p=0.0001). LV 2D-LS (OR=1.34, p<0.0001) and 2D-RS (OR=1.07, p=0.03) were also associated with adverse clinical outcome (NYHA class>=3, history of clinically relevant arrhythmia, ventricular tachycardia or death) on univariate logistic regression analysis. On multivariate analysis LV 2D-LS emerged as the strongest echocardiographic predictor of outcome, independently of LV dimensions and EF.
Conclusion: LV longitudinal and radial global systolic strain are significantly reduced in ToF patients compared to controls and are related to RV dysfunction and enlargement. Measures of myocardial deformation are more sensitive in detecting early myocardial damage and outperformed LV EF and LV dimensions in predicting adverse clinical outcome in this study.
- © 2010 by American Heart Association, Inc.