TY - JOUR
T1 - Right-left ventricular shape variations in tetralogy of Fallot
T2 - associations with pulmonary regurgitation
AU - Mauger, Charlène A.
AU - Govil, Sachin
AU - Chabiniok, Radomir
AU - Gilbert, Kathleen
AU - Hegde, Sanjeet
AU - Hussain, Tarique
AU - McCulloch, Andrew D.
AU - Occleshaw, Christopher J.
AU - Omens, Jeffrey
AU - Perry, James C.
AU - Pushparajah, Kuberan
AU - Suinesiaputra, Avan
AU - Zhong, Liang
AU - Young, Alistair A.
N1 - Funding Information:
Funding was provided by the National Institutes of Health (USA) R01HL121754 and AHA Grant 19AIML35120034. SG acknowledges National Institutes of Health NHLBI 1T32HL105373. AY acknowledges Health Research Council of New Zealand grant 17/234. CM acknowledges New Zealand Heart Foundation Grant 1695. RC and TH acknowledge the support of Inria-UTSW Medical Center Dallas Associated Team TOFMOD, and RC additionally the support of the Ministry of Health of the Czech Republic (project No. NV19-08-00071). LZ acknowledges National Medical Research Council of Singapore Grant (NMRC/OFIRG/0018/2016).
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background: Relationships between right ventricular (RV) and left ventricular (LV) shape and function may be useful in determining optimal timing for pulmonary valve replacement in patients with repaired tetralogy of Fallot (rTOF). However, these are multivariate and difficult to quantify. We aimed to quantify variations in biventricular shape associated with pulmonary regurgitant volume (PRV) in rTOF using a biventricular atlas. Methods: In this cross-sectional retrospective study, a biventricular shape model was customized to cardiovascular magnetic resonance (CMR) images from 88 rTOF patients (median age 16, inter-quartile range 11.8–24.3 years). Morphometric scores quantifying biventricular shape at end-diastole and end-systole were computed using principal component analysis. Multivariate linear regression was used to quantify biventricular shape associations with PRV, corrected for age, sex, height, and weight. Regional associations were confirmed by univariate correlations with distances and angles computed from the models, as well as global systolic strains computed from changes in arc length from end-diastole to end-systole. Results: PRV was significantly associated with 5 biventricular morphometric scores, independent of covariates, and accounted for 12.3% of total shape variation (p < 0.05). Increasing PRV was associated with RV dilation and basal bulging, in conjunction with decreased LV septal-lateral dimension (LV flattening) and systolic septal motion towards the RV (all p < 0.05). Increased global RV radial, longitudinal, circumferential and LV radial systolic strains were significantly associated with increased PRV (all p < 0.05). Conclusion: A biventricular atlas of rTOF patients quantified multivariate relationships between left–right ventricular morphometry and wall motion with pulmonary regurgitation. Regional RV dilation, LV reduction, LV septal-lateral flattening and increased RV strain were all associated with increased pulmonary regurgitant volume. Morphometric scores provide simple metrics linking mechanisms for structural and functional alteration with important clinical indices.
AB - Background: Relationships between right ventricular (RV) and left ventricular (LV) shape and function may be useful in determining optimal timing for pulmonary valve replacement in patients with repaired tetralogy of Fallot (rTOF). However, these are multivariate and difficult to quantify. We aimed to quantify variations in biventricular shape associated with pulmonary regurgitant volume (PRV) in rTOF using a biventricular atlas. Methods: In this cross-sectional retrospective study, a biventricular shape model was customized to cardiovascular magnetic resonance (CMR) images from 88 rTOF patients (median age 16, inter-quartile range 11.8–24.3 years). Morphometric scores quantifying biventricular shape at end-diastole and end-systole were computed using principal component analysis. Multivariate linear regression was used to quantify biventricular shape associations with PRV, corrected for age, sex, height, and weight. Regional associations were confirmed by univariate correlations with distances and angles computed from the models, as well as global systolic strains computed from changes in arc length from end-diastole to end-systole. Results: PRV was significantly associated with 5 biventricular morphometric scores, independent of covariates, and accounted for 12.3% of total shape variation (p < 0.05). Increasing PRV was associated with RV dilation and basal bulging, in conjunction with decreased LV septal-lateral dimension (LV flattening) and systolic septal motion towards the RV (all p < 0.05). Increased global RV radial, longitudinal, circumferential and LV radial systolic strains were significantly associated with increased PRV (all p < 0.05). Conclusion: A biventricular atlas of rTOF patients quantified multivariate relationships between left–right ventricular morphometry and wall motion with pulmonary regurgitation. Regional RV dilation, LV reduction, LV septal-lateral flattening and increased RV strain were all associated with increased pulmonary regurgitant volume. Morphometric scores provide simple metrics linking mechanisms for structural and functional alteration with important clinical indices.
KW - Atlases
KW - Cardiovascular magnetic resonance
KW - Myocardial deformation
KW - Tetralogy of Fallot
KW - Ventricular function
UR - http://www.scopus.com/inward/record.url?scp=85116434502&partnerID=8YFLogxK
U2 - 10.1186/s12968-021-00780-x
DO - 10.1186/s12968-021-00780-x
M3 - Article
AN - SCOPUS:85116434502
SN - 1097-6647
VL - 23
JO - Journal of Cardiovascular Magnetic Resonance
JF - Journal of Cardiovascular Magnetic Resonance
IS - 1
M1 - 105
ER -