Clinical Investigation
Valvular and Congenital Heart Disease
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

https://doi.org/10.1016/j.ahj.2012.01.038Get rights and content

Background

Transposition of the great arteries (TGA) after atrial switch operation and congenitally corrected TGA (ccTGA) are commonly associated with impaired systemic right ventricular (RV) function and impaired prognosis. We aimed to investigate the value of indices of myocardial deformation on speckle-tracking echocardiography for quantifying ventricular function and their potential role in assessing ventricular-ventricular interaction and outcome in patients with a systemic RV.

Methods and Results

A total of 129 patients (87 with TGA and atrial switch and 42 with ccTGA, 71 men, age 35 ± 12 years) were investigated, and biventricular myocardial deformation was compared with findings in healthy subjects (n = 38, age 36 ± 10 years). Systemic ventricular longitudinal 2-dimensional (2D) peak systolic strain (RV 2D-LS) was significantly reduced compared with controls (−12.9 ± 3.6 and −15.4 ± 5.1 vs −21.0 ± 5.5 in TGAs, ccTGAs, and controls, P < .0001). Systemic and pulmonary 2D-LS were correlated in patients with TGA (r = 0.46, P < .0001) and ccTGA (r = 0.64, P < .0001), suggesting interventricular interaction, and this was confirmed when ejection fraction on magnetic resonance imaging was assessed (r = 0.53, P < .0001). More importantly, systemic 2D-LS (hazard ratio 1.31, P = .01) was related to adverse clinical outcome (symptomatic progression to New York Heart Association class ≥3, clinically relevant cardiac arrhythmia, or death) in patients with TGA and atrial switch independently of ejection fraction on cardiac magnetic resonance imaging, history of clinically relevant arrhythmia, or functional class.

Conclusions

Global longitudinal systolic strain is significantly reduced in patients with a systemic RV, is related to subpulmonary ventricular function, and predicts adverse clinical outcome in adults with atrial switch TGA.

Section snippets

Patients and methods

We identified patients with a systemic RV who attended the Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, and the Adult Congenital and Valvular Heart Disease Center at the University of Münster, Germany, and had undergone a transthoracic echocardiogram between May 2005 and April 2010. Patients in whom adequate echocardiographic sequences were not recorded or digitally stored were excluded. For those patients who had ≥1 echocardiographic investigation during this

Results

Overall, 129 consecutive patients with a systemic RV (87 with TGA and atrial switch and 42 with ccTGA, 71 men, age 35 ± 12 years) in whom adequate echocardiographic recordings were available were included. Patients' demographics are presented in Table I.

Discussion

The present study demonstrates that biventricular 2D-LS is reduced in adult patients with a systemic RV and relates to adverse clinical outcome in this setting. Systemic and subpulmonary myocardial functions appear interrelated in patients with TGA, suggesting adverse ventriculo-ventricular interaction, and the relationship between systemic and subpulmonary ventricular functions was found to be most pronounced in patients with ccTGA and pulmonary stenosis.

Previous studies have demonstrated

Conclusions

Systemic 2D-LS is significantly reduced in patients with a systemic RV and relates to worse clinical outcome in the setting of atrial switch TGA. Systemic and subpulmonary myocardial functions appear interrelated, and this may be because of adverse ventriculo-ventricular interaction. Right ventricular 2D-LS is readily available from routine echocardiography using modern commercial analysis software, represents an objective measure of systemic RV function, and should assist clinicians in

Disclosures

Conflict of interest: None of the authors has any conflict of interest.

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