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Eur Heart J Cardiovasc Imaging. 2014 Dec;15(12):1333-43. doi: 10.1093/ehjci/jeu123. Epub 2014 Jul 4.

Patients with repaired tetralogy of Fallot suffer from intra- and inter-ventricular cardiac dyssynchrony: a cardiac magnetic resonance study.

Author information

1
Departments of Pediatrics, Physiology, Biomedical Engineering and Medicine, University of Kentucky, UK Chandler Hospital, 741 S Limestone, BBSRB B353, Lexington, KY 40536, USA.
2
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
3
Scientific Imaging and Visualization LLC, Atlanta, GA, USA.
4
Departments of Pediatrics, Physiology, Biomedical Engineering and Medicine, University of Kentucky, UK Chandler Hospital, 741 S Limestone, BBSRB B353, Lexington, KY 40536, USA bkf@gatech.edu b.f@uky.edu.

Abstract

AIMS:

Patients with repaired tetralogy of Fallot (rTOF) frequently have right bundle branch block. To better understand the contribution of cardiac dyssynchrony to dysfunction, we developed a method to quantify left (LV), right (RV), and inter-ventricular dyssynchrony using standard cine cardiac magnetic resonance (CMR).

METHODS AND RESULTS:

Thirty patients with rTOF and 17 healthy controls underwent cine CMR. Patients were imaged twice to assess inter-test reproducibility. Circumferential strain curves were generated with a custom feature-tracking algorithm for 12 LV and 12 RV segments in each of 4-7 short-axis slices encompassing the ventricles. Temporal offsets (TOs, in ms) of the strain curves relative to a patient-specific reference curve were calculated. The intra-ventricular dyssynchrony index (DI) for each ventricle was computed as the standard deviation of the TOs. The inter-ventricular DI was calculated as the difference in median RV and median LV TOs. Compared with controls, patients had a greater LV DI (21 ± 8 vs. 11 ± 5 ms, P < 0.001) and RV DI (60 ± 19 vs. 47 ± 17 ms, P = 0.02). RV contraction was globally delayed in patients, resulting in a greater inter-ventricular DI with the RV contracting 45 ± 25 ms later than the LV vs. 12 ± 29 ms earlier in controls (P < 0.001). Inter-test reproducibility was moderate with all coefficients of variation ≤22%. Both LV and RV DIs were correlated with measures of LV, but not RV, function.

CONCLUSION:

Patients with rTOF have intra- and inter-ventricular dyssynchrony, which can be quantified from standard cine CMR. This new approach can potentially help determine the contribution of dyssynchrony to ventricular dysfunction in future studies.

KEYWORDS:

Cardiac magnetic resonance; Dyssynchrony; Magnetic resonance imaging; Tetralogy of Fallot

PMID:
24996664
PMCID:
PMC4432392
DOI:
10.1093/ehjci/jeu123
[Indexed for MEDLINE]
Free PMC Article

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