A Pilot Project to Identify Simple Echocardiographic Tools as an Alternative to Cardiac Magnetic Resonance Imaging to Predict a Reduced Right Ventricular Ejection Fraction in Patients with Repaired Tetralogy of Fallot
Background: Right ventricular (RV) dysfunction is an important predictor of adverse events after tetralogy of Fallot (TOF) repair. A study comparing echocardiography with cardiac magnetic resonance (CMR) might provide simple tools for their serial inexpensive assessment. Methods: Echocardiographic R...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of the Indian Academy of Echocardiography & Cardiovascular Imaging |
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| Online Access: | http://www.jiaecho.org/article.asp?issn=2543-1463;year=2022;volume=6;issue=1;spage=13;epage=20;aulast=Mohakud |
| _version_ | 1818234088270594048 |
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| author | Asish Ranjan Mohakud Kothandam Sivakumar Arvind Sahay Singh Pramod Sagar |
| author_facet | Asish Ranjan Mohakud Kothandam Sivakumar Arvind Sahay Singh Pramod Sagar |
| author_sort | Asish Ranjan Mohakud |
| collection | DOAJ |
| description | Background: Right ventricular (RV) dysfunction is an important predictor of adverse events after tetralogy of Fallot (TOF) repair. A study comparing echocardiography with cardiac magnetic resonance (CMR) might provide simple tools for their serial inexpensive assessment. Methods: Echocardiographic RV functional parameters including fractional area change (FAC), rate of pressure rise (dP/dt), free wall strain, myocardial performance index (MPI), tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler S' velocity in patients with repaired TOF were correlated with CMR-derived ejection fraction (EF) using receiver operator characteristic (ROC) curves. Bland–Altman plots analyzed agreement between the RV end-diastolic volumes (EDVs), end-systolic volumes (ESVs), and EF derived from three-dimensional echocardiography (3DE) and CMR. Results: Eighteen patients were included. The echocardiographic parameters that showed a good positive correlation with CMR-derived EF were FAC (r = 0.851, P = 0.001), dP/dt (r = 0.730, P = 0.001), and free wall strain (r = −0.660, P = 0.003). ROC curve analysis provided a cutoff value for FAC (<36.6), dP/dt (<370 mmHg/s), free wall strain (<−18.5) and MPI (>0.565) to predict EF <45%. TAPSE and S' velocity had poor correlation. Correlation was strong between 3DE and CMR-derived EDV (r = 0.938, P <0.001), ESV (r = 0.936, P <0.001) and EF (r = 0.916, P <0.001). 3DE underestimated volumes compared to CMR with a mean bias of − 31.78 ± 18.8 ml for EDV and −17.28 ± 11.6 ml for ESV, but EF was not affected (mean bias − 1% ± 3.7%). Conclusions: RV free wall strain, FAC and dP/dt were simple tools with good accuracy to predict RV EF <45% in patients with repaired TOF. TAPSE and S' velocity assessed basal longitudinal function without considering the dysfunctional outflow tract and showed poor correlation. EF assessment by 3DE was a good alternative to CMR. Underestimation of volumes by 3DE might restrict its use in timing surgery. |
| first_indexed | 2024-12-12T11:32:31Z |
| format | Article |
| id | doaj.art-c15410ea97a241998ebc8298ea5e2686 |
| institution | Directory Open Access Journal |
| issn | 2543-1463 2543-1471 |
| language | English |
| last_indexed | 2024-12-12T11:32:31Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of the Indian Academy of Echocardiography & Cardiovascular Imaging |
| spelling | doaj.art-c15410ea97a241998ebc8298ea5e26862022-12-22T00:25:44ZengWolters Kluwer Medknow PublicationsJournal of the Indian Academy of Echocardiography & Cardiovascular Imaging2543-14632543-14712022-01-0161132010.4103/jiae.jiae_26_21A Pilot Project to Identify Simple Echocardiographic Tools as an Alternative to Cardiac Magnetic Resonance Imaging to Predict a Reduced Right Ventricular Ejection Fraction in Patients with Repaired Tetralogy of FallotAsish Ranjan MohakudKothandam SivakumarArvind Sahay SinghPramod SagarBackground: Right ventricular (RV) dysfunction is an important predictor of adverse events after tetralogy of Fallot (TOF) repair. A study comparing echocardiography with cardiac magnetic resonance (CMR) might provide simple tools for their serial inexpensive assessment. Methods: Echocardiographic RV functional parameters including fractional area change (FAC), rate of pressure rise (dP/dt), free wall strain, myocardial performance index (MPI), tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler S' velocity in patients with repaired TOF were correlated with CMR-derived ejection fraction (EF) using receiver operator characteristic (ROC) curves. Bland–Altman plots analyzed agreement between the RV end-diastolic volumes (EDVs), end-systolic volumes (ESVs), and EF derived from three-dimensional echocardiography (3DE) and CMR. Results: Eighteen patients were included. The echocardiographic parameters that showed a good positive correlation with CMR-derived EF were FAC (r = 0.851, P = 0.001), dP/dt (r = 0.730, P = 0.001), and free wall strain (r = −0.660, P = 0.003). ROC curve analysis provided a cutoff value for FAC (<36.6), dP/dt (<370 mmHg/s), free wall strain (<−18.5) and MPI (>0.565) to predict EF <45%. TAPSE and S' velocity had poor correlation. Correlation was strong between 3DE and CMR-derived EDV (r = 0.938, P <0.001), ESV (r = 0.936, P <0.001) and EF (r = 0.916, P <0.001). 3DE underestimated volumes compared to CMR with a mean bias of − 31.78 ± 18.8 ml for EDV and −17.28 ± 11.6 ml for ESV, but EF was not affected (mean bias − 1% ± 3.7%). Conclusions: RV free wall strain, FAC and dP/dt were simple tools with good accuracy to predict RV EF <45% in patients with repaired TOF. TAPSE and S' velocity assessed basal longitudinal function without considering the dysfunctional outflow tract and showed poor correlation. EF assessment by 3DE was a good alternative to CMR. Underestimation of volumes by 3DE might restrict its use in timing surgery.http://www.jiaecho.org/article.asp?issn=2543-1463;year=2022;volume=6;issue=1;spage=13;epage=20;aulast=Mohakudbland–altman plotscomparative studycutoff discriminationreceiver operator characteristic curvesright ventricular systolic functionthree-dimensional echocardiography |
| spellingShingle | Asish Ranjan Mohakud Kothandam Sivakumar Arvind Sahay Singh Pramod Sagar A Pilot Project to Identify Simple Echocardiographic Tools as an Alternative to Cardiac Magnetic Resonance Imaging to Predict a Reduced Right Ventricular Ejection Fraction in Patients with Repaired Tetralogy of Fallot Journal of the Indian Academy of Echocardiography & Cardiovascular Imaging bland–altman plots comparative study cutoff discrimination receiver operator characteristic curves right ventricular systolic function three-dimensional echocardiography |
| title | A Pilot Project to Identify Simple Echocardiographic Tools as an Alternative to Cardiac Magnetic Resonance Imaging to Predict a Reduced Right Ventricular Ejection Fraction in Patients with Repaired Tetralogy of Fallot |
| title_full | A Pilot Project to Identify Simple Echocardiographic Tools as an Alternative to Cardiac Magnetic Resonance Imaging to Predict a Reduced Right Ventricular Ejection Fraction in Patients with Repaired Tetralogy of Fallot |
| title_fullStr | A Pilot Project to Identify Simple Echocardiographic Tools as an Alternative to Cardiac Magnetic Resonance Imaging to Predict a Reduced Right Ventricular Ejection Fraction in Patients with Repaired Tetralogy of Fallot |
| title_full_unstemmed | A Pilot Project to Identify Simple Echocardiographic Tools as an Alternative to Cardiac Magnetic Resonance Imaging to Predict a Reduced Right Ventricular Ejection Fraction in Patients with Repaired Tetralogy of Fallot |
| title_short | A Pilot Project to Identify Simple Echocardiographic Tools as an Alternative to Cardiac Magnetic Resonance Imaging to Predict a Reduced Right Ventricular Ejection Fraction in Patients with Repaired Tetralogy of Fallot |
| title_sort | pilot project to identify simple echocardiographic tools as an alternative to cardiac magnetic resonance imaging to predict a reduced right ventricular ejection fraction in patients with repaired tetralogy of fallot |
| topic | bland–altman plots comparative study cutoff discrimination receiver operator characteristic curves right ventricular systolic function three-dimensional echocardiography |
| url | http://www.jiaecho.org/article.asp?issn=2543-1463;year=2022;volume=6;issue=1;spage=13;epage=20;aulast=Mohakud |
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