Inter- and intra-ventricular dyssynchrony in the systemic right ventricle is a surrogate marker of major cardiac events in mildly symptomatic patients
- 119 Downloads
The aim of the study was to evaluate systemic right ventricular (RV) dyssynchrony in patients with congenitally corrected transposition of the great arteries (CCTGA) and transposition of the great arteries (TGA) with New York Heart Association functional class (NYHA FC) < III. We used cardiac magnetic resonance (CMR) to evaluate the dyssynchrony and assessed whether RV dyssynchrony can be predictive of major cardiac events in their early stages in these patients. We enrolled 71 consecutive, NYHA FC < III patients with systemic RV who underwent CMR between April 1995 and December 2016. We measured intra- and inter-ventricular dyssynchrony using a feature-tracking method of cine magnetic resonance imaging. The predictors of major cardiac events were analyzed using the Cox hazard analysis. The data from 36 patients with CCTGA and 35 patients with TGA after an atrial switch were analyzed. Seven (19.4%) patients with CCTGA and 6 (17.1%) patients with TGA showed a QRS duration of ≥ 130 ms. There were significant intra- and inter-dyssynchrony in the systemic RV groups, compared to healthy controls. The average follow-up period was 5.1 ± 3.9 years. From among patients with CCTGA, 9 (25.0%) had major cardiac events. The parameters including NYHA FC, indexed RV volume, longitudinal early diastolic strain rate, and intra- and inter-ventricular dyssynchrony were predictive of major cardiac events. From among patients with TGA, 12 (34.3%) had major cardiac events. Age, NYHA FC, QRS duration, RV volume, RV mass index, LV volume, global longitudinal/circumferential strain and intraventricular dyssynchrony, were all predictive of major cardiac events. Systemic RV in NYHA FC < III patients with CCTGA and TGA, have obvious intra- and inter-dyssynchrony, suggesting ineffective wall motion and potential RV dysfunction. Intraventricular dyssynchrony can be an adjunct predictor of major cardiac events in mildly symptomatic patients with both CCTGA and TGA.
KeywordsSystemic right ventricle Congenitally corrected transposition of the great arteries Transposition of the great arteries Cardiac dyssynchrony Cardiac magnetic resonance
We would like to thank Editage (http://www.editage.jp) for English language editing.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest, financial or otherwise, related to this study.
- 3.Hauser M, Bengel FM, Hager A, Kuehn A, Nekolla SG, Kaemmerer H, Schwaiger M, Hess J (2003) Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic ventricle in patients with congenitally corrected transposition of the great arteries. Heart 89(10):1231–1235CrossRefPubMedPubMedCentralGoogle Scholar
- 7.van der Bom T, Winter MM, Groenink M, Vliegen HW, Pieper PG, van Dijk AP, Sieswerda GT, Roos-Hesselink JW, Zwinderman AH, Mulder BJ, Bouma BJ (2013) Right ventricular end-diastolic volume combined with peak systolic blood pressure during exercise identifies patients at risk for complications in adults with a systemic right ventricle. J Am Coll Cardiol 62(10):926–936CrossRefPubMedGoogle Scholar
- 8.Diller GP, Radojevic J, Kempny A, Alonso-Gonzalez R, Emmanouil L, Orwat S, Swan L, Uebing A, Li W, Dimopoulos K, Gatzoulis MA, Baumgartner H (2012) Systemic right ventricular longitudinal strain is reduced in adults with transposition of the great arteries, relates to subpulmonary ventricular function, and predicts adverse clinical outcome. Am Heart J 163(5):859–866CrossRefPubMedGoogle Scholar
- 9.Babu-Narayan SV, Prati D, Rydman R, Dimopoulos K, Diller GP, Uebing A, Henein MY, Kilner PJ, Gatzoulis MA, Li W (2016) Dyssynchrony and electromechanical delay are associated with focal fibrosis in the systemic right ventricle—insights from echocardiography. Int J Cardiol 220:382–388CrossRefPubMedGoogle Scholar
- 11.Plymen CM, Hughes ML, Picaut N, Panoulas VF, Macdonald ST, Cullen S, Deanfield JE, Walker F, Taylor AM, Lambiase PD, Bolger AP (2010) The relationship of systemic right ventricular function to ECG parameters and NT-proBNP levels in adults with transposition of the great arteries late after Senning or Mustard surgery. Heart 96:1569–1573CrossRefPubMedGoogle Scholar
- 12.Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NA 3rd, Ferguson TB Jr, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD, Ellenbogen KA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hayes DL, Page RL, Stevenson LW, Sweeney MO, American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Heart Rhythm Society (2012) 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 126:1784–1800CrossRefPubMedGoogle Scholar
- 14.Janousek J, Gebauer RA, Abdul-Khaliq H, Turner M, Kornyei L, Grollmuss O, Rosenthal E, Villain E, Fruh A, Paul T, Blom NA, Happonen JM, Bauersfeld U, Jacobsen JR, van den Heuvel F, Delhaas T, Papagiannis J, Trigo C (2009) Cardiac resynchronization therapy in paediatric and congenital heart disease: differential effects in various anatomical and functional substrates. Heart 95:1165–1171CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Van de Veire NR, Blom NA, Holman ER, Schalij MJ, Bax JJ (2007) Triplane tissue Doppler imaging to evaluate mechanical dyssynchrony before and after cardiac resynchronization in a patient with congenitally corrected transposition of the great arteries. J Cardiovasc Electrophysiol 18(2):222–225CrossRefPubMedGoogle Scholar
- 20.Pettersen E, Helle-Valle T, Edvardsen T, Lindberg H, Smith HJ, Smevik B, Smiseth OA, Andersen K (2007) Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49(25):2450–2456CrossRefPubMedGoogle Scholar
- 22.Franzoso FD, Wohlmuth C, Greutmann M, Kellenberger CJ, Oxenius A, Voser EM, Valsangiacomo Buechel ER (2016) Atrial function after the atrial switch operation for transposition of the great arteries: comparison with arterial switch and normals by cardiovascular magnetic resonance. Congenit Heart Dis 11(5):426–436CrossRefPubMedGoogle Scholar