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Evaluation of tricuspid annular plane systolic excursion measured with cardiac MRI in children with tetralogy of Fallot

Published online by Cambridge University Press:  17 August 2015

Jonathan H. Soslow*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
Emem Usoro
Affiliation:
Meharry Medical College, Nashville, TN 37208, United States of America
Li Wang
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
David A. Parra
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
*
Correspondence to: J. H. Soslow, MD, MSCI, Vanderbilt University Medical Center, 2200 Children’s Way, Suite 5230, DOT, Nashville, TN 37232, United States of America. Tel: +615 322 7447; Fax: +615 322 2210; E-mail: jonathan.h.soslow@vanderbilt.edu

Abstract

Background

Aneurysmal dilation of the right ventricular outflow tract complicates assessment of right ventricular function in patients with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is commonly used to estimate ejection fraction. We hypothesised that tricuspid annular plane systolic excursion measured by cardiac MRI approximates global and segmental right ventricular function, specifically right ventricular sinus ejection fraction, in children with repaired tetralogy of Fallot.

Methods

Tricuspid annular plane systolic excursion was measured retrospectively on cardiac MRIs in 54 patients with repaired tetralogy of Fallot. Values were compared with right ventricular global, sinus, and infundibular ejection fractions. Tricuspid annular plane systolic excursion was indexed to body surface area, converted into a fractional value, and converted into published paediatric Z-scores.

Results

Tricuspid annular plane systolic excursion measurements had good agreement between observers. Right ventricular ejection fraction did not correlate with the absolute or indexed tricuspid annular plane systolic excursion and correlated weakly with fractional tricuspid annular plane systolic excursion (r=0.41 and p=0.002). Segmental right ventricular function did not appreciably improve correlation with any of the tricuspid annular plane systolic excursion measures. Paediatric Z-scores were unable to differentiate patients with normal and abnormal right ventricular function.

Conclusions

Tricuspid annular plane systolic excursion measured by cardiac MRI correlates poorly with global and segmental right ventricular ejection fraction in children with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is an unreliable approximation of right ventricular function in this patient population.

Type
Original Articles
Copyright
© Cambridge University Press 2015 

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