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J Am Soc Echocardiogr. 2015 Sep;28(9):1036-44. doi: 10.1016/j.echo.2015.05.010. Epub 2015 Jun 24.

Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation.

Author information

1
Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: chowdhur@musc.edu.
2
Department of Pediatrics, Sidra Medical and Research Center, Doha, Qatar.
3
Department of Pediatrics, Yale-New Haven Hospital, New Haven, Connecticut.
4
Department of Pediatrics, Miami Children's Hospital, Miami, Florida.
5
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
6
Department of Medicine, The Heart Hospital, London, United Kingdom.
7
Rush Center for Congenital & Structural Heart Disease, Rush University Medical Center, Chicago, Illinois.
8
The Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri.

Abstract

BACKGROUND:

Speckle-tracking echocardiographic (STE) measures of right ventricular (RV) function appear to improve after transcatheter pulmonary valve implantation (TPVI). Measures of exercise function, such as ventilatory efficiency (the minute ventilation [VE]/carbon dioxide production [VCO2] slope), have been shown to be prognostic of mortality in patients who may require TPVI. The aim of this study was to evaluate the correlation between STE measures of RV function and changes in VE/VCO2 after TPVI.

METHODS:

Speckle-tracking echocardiography and cardiopulmonary exercise testing were performed at baseline and 6 months after TPVI in 24 patients from four centers. Conventional echocardiographic measures of RV function were also assessed. Echocardiographic and exercise stress test results were interpreted by single blinded observers at separate core laboratories.

RESULTS:

All patients demonstrated relief of pulmonary regurgitation and stenosis after TPVI. Improvements in RV longitudinal strain (-16.9 ± 3.5% vs -19.7 ± 4.3%, P < .01) and strain rate (-0.9 ± 0.4 vs. -1.2 ± 0.4 s(-1), P < .01) were noted. The VE/VCO2 slope improved (32.4 ± 5.7 vs 31.5 ± 8.8, P = .03). No other significant echocardiographic or exercise changes were found. On multivariate regression, the change in VE/VCO2 was independently associated with change in RV longitudinal early diastolic strain rate (P < .001) and tricuspid A velocity (P < .001). Preintervention RV longitudinal strain was found to be a predictor of change in VE/VCO2 after TPVI (r = -0.60, P < .001).

CONCLUSIONS:

STE measures of RV function appear to hold the potential for use as predictors of improved outcomes in patients requiring TPVI. Future studies should directly assess the prognostic significance of STE measures of RV function in this population.

KEYWORDS:

Congenital heart disease; Speckle-tracking echocardiography; Transcatheter pulmonary valve implantation

PMID:
26117295
PMCID:
PMC4567395
DOI:
10.1016/j.echo.2015.05.010
[Indexed for MEDLINE]
Free PMC Article

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