• Users Online: 127
  • Print this page
  • Email this page
ORIGINAL RESEARCH
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 13-20

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


Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Kothandam Sivakumar
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4-A Dr. JJ Nagar, Mogappair, Chennai - 600 037, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_26_21

Rights and Permissions

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.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed1354    
    Printed42    
    Emailed0    
    PDF Downloaded109    
    Comments [Add]    

Recommend this journal