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      Afterload dependence of right ventricular myocardial deformation: A comparison between tetralogy of Fallot and atrially corrected transposition of the great arteries in adult patients

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Prior studies suggested that myocardial deformation is superior to conventional measures for assessing ventricular function. This study aimed to evaluate right ventricular (RV) myocardial deformation in response to increased afterload. Patients with the RV in the systemic position were compared with patients with the RV in the sub-pulmonic position with normal or only slightly elevated systolic right ventricular pressure. Correlations between global longitudinal strain (GLS), radial strain, atrioventricular plane displacement (AVPD), and exercise capacity were evaluated.

          Methods

          44 patients with congenital heart defect were enrolled in the study. The control group consisted of seven healthy volunteers. All patients underwent cardiovascular magnetic resonance (CMR) and cardiopulmonary exercise testing. We assessed biventricular myocardial function using CMR based feature tracking and compared the results to anatomic volumes.

          Results

          Strain analysis and displacement measurements were feasible in all participants. RVGLS and RVAVPD were reduced in both study groups compared to the control group (p<0.001). Left ventricular (LV) radial strain was significantly lower in patients with a systemic RV than in those with a subpulmonic RV and lower than in controls (p<0.001). Both LVAVPD and RVAVPD were significantly depressed in patients compared to controls (p<0.05). RVAVPD was more depressed in patients with a high systolic RV pressure than in those with normal RV pressure (p<0.001). RVAVPD did not correlate with exercise capacity in either study group. Exercise capacity in both patient groups was depressed to levels reported in previous studies, and did not correlate with RVGLS.

          Conclusions

          Both study groups had abnormal myocardial deformation and increased RV volumes. RVGLS in patients was lower than in controls, confirming the effect of increased afterload on myocardial performance.

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          Most cited references 30

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          ESC Guidelines for the management of grown-up congenital heart disease (new version 2010).

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            Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure.

            We sought to study the relationship between survival and right ventricular ejection fraction (RVEF) in a subgroup of patients with moderate congestive heart failure (CHF). It has been demonstrated that RVEF is an independent predictor of survival in patients with advanced CHF. Cardiopulmonary exercise testing and radionuclide angiography (to determine right and left ventricular ejection fraction) were prospectively performed in 205 consecutive patients with moderate CHF (140 patients in New York Heart Association [NYHA] class II, 65 in class III). Left ventricular ejection fraction was 29.3%+/-10.1%, RVEF was 37.5%+/-14.6% and peak oxygen consumption (VO2) was 16.2+/-5.4 ml/min/kg (60.2%+/-19% of maximal predicted VO2). After a median follow-up period of 755 days, there were 44 cardiac-related deaths, 3 deaths from noncardiac causes and 15 transplantations of whom 2 were urgent; 1 patient was lost to follow-up. Multivariate analysis showed that three variables-NYHA classification, percent of maximal predicted VO2 and RVEF-were independent predictors of both survival and event-free cardiac survival. Left ventricular ejection fraction and peak VO2 normalized to body weight had no predictive value. The event-free survival rates from cardiovascular mortality and urgent transplantation at 1 year were 80%, 90% and 95% in patients with an RVEF or =25% and or =35%, respectively. At 2 years, survival rates were 59%, 77% and 93% in the same subgroups, respectively. In addition to the NYHA classification and to the percent of maximal predicted VO2, RVEF is an independent predictor of survival in patients with moderate CHF.
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              Anatomy, echocardiography, and normal right ventricular dimensions.

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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Writing – original draft
                Role: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: Funding acquisitionRole: Methodology
                Role: SupervisionRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 September 2018
                2018
                : 13
                : 9
                Affiliations
                [1 ] Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
                [2 ] Department of Clinical Physiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
                [3 ] Department of Clinical Physiology, Kalmar County Hospital and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
                [4 ] Centre for Medical Image Science and Visualization (CMIV), Linkoping University, Linkoping Sweden
                Faculty of Medical Science - State University of Campinas, BRAZIL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-18-10803
                10.1371/journal.pone.0204435
                6160038
                30261015
                © 2018 Trzebiatowska-Krzynska et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 9, Tables: 4, Pages: 19
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100003945, Linköpings Universitet;
                Award ID: 281281
                Award Recipient :
                This study was funded by ALF Grant, Region Ostergotland, LIO-281281 to JE; www.fou.nu/is/lio. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Anatomy
                Cardiovascular Anatomy
                Heart
                Cardiac Ventricles
                Medicine and Health Sciences
                Anatomy
                Cardiovascular Anatomy
                Heart
                Cardiac Ventricles
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Systolic Pressure
                Medicine and Health Sciences
                Public and Occupational Health
                Physical Activity
                Physical Fitness
                Exercise
                Medicine and Health Sciences
                Sports and Exercise Medicine
                Exercise
                Biology and Life Sciences
                Sports Science
                Sports and Exercise Medicine
                Exercise
                Medicine and Health Sciences
                Sports and Exercise Medicine
                Biology and Life Sciences
                Sports Science
                Sports and Exercise Medicine
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Physical Sciences
                Chemistry
                Chemical Elements
                Oxygen
                Physical Sciences
                Physics
                Classical Mechanics
                Deformation
                Physical Sciences
                Physics
                Classical Mechanics
                Damage Mechanics
                Deformation
                Biology and Life Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Arteries
                Medicine and Health Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Arteries
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Uncategorized

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