Heart and Vessels

, Volume 33, Issue 9, pp 1086–1093 | Cite as

Inter- and intra-ventricular dyssynchrony in the systemic right ventricle is a surrogate marker of major cardiac events in mildly symptomatic patients

  • Yumi Shiina
  • Kei InaiEmail author
  • Tatsunori Takahashi
  • Kota Taniguchi
  • Eri Watanabe
  • Kenji Fukushima
  • Koichiro Niwa
  • Michinobu Nagao
Original Article


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.


Systemic 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 ( 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.


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Yumi Shiina
    • 1
    • 2
  • Kei Inai
    • 1
    Email author
  • Tatsunori Takahashi
    • 1
  • Kota Taniguchi
    • 1
  • Eri Watanabe
    • 3
  • Kenji Fukushima
    • 4
  • Koichiro Niwa
    • 2
  • Michinobu Nagao
    • 4
  1. 1.Division of Adult Congenital Heart Disease Pathophysiology and Life‑long Care, Department of Pediatric CardiologyTokyo Women’s Medical UniversityTokyoJapan
  2. 2.Cardiovascular CenterSt. Luke’s International HospitalTokyoJapan
  3. 3.Department of CardiologyTokyo Women’s Medical UniversityTokyoJapan
  4. 4.Department of Diagnostic Imaging and Nuclear MedicineTokyo Women’s Medical UniversityTokyoJapan

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