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Exercise echocardiography demonstrates potential myocardial damage in patients with repaired tetralogy of Fallot using layer-specific strain analysis

Published online by Cambridge University Press:  04 May 2020

Kana Yazaki
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Ken Takahashi*
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Maki Kobayashi
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Mariko Yamada
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Takeshi Iso
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Satoshi Akimoto
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Sachie Shigemitsu
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Kotoko Matsui
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Katsumi Akimoto
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Masahiko Kishiro
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
Keisuke Nakanishi
Affiliation:
Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Shiori Kawasaki
Affiliation:
Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
Toshiaki Shimizu
Affiliation:
Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
*
Author for correspondence: Ken Takahashi, MD, PhD, Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. Tel: +81-3-3813-3111; Fax: +81-3-5800-0216; E-mail: kentaka@juntendo.ac.jp

Abstract

Introduction:

Exercise stress echocardiography and layer-specific strains are emerging as important tools for cardiac assessment. This study was aimed to evaluate layer-specific strains and torsion parameters during exercise in order to investigate the characteristics of cardiac dysfunction in patients with repaired tetralogy of Fallot and to detect subclinical left ventricular dysfunction.

Materials and Methods:

Thirteen patients with repaired tetralogy of Fallot (median age, 17.3 [interquartile range, 14.5–22.9] years; 6 males) and 13 controls (median age, 28.5 [interquartile range, 27.6–31.6] years; 13 males) underwent echocardiography at rest and during supine exercise. Layer-specific longitudinal strain and circumferential strain of three myocardial layers (endocardium, midmyocardium, and epicardium), torsion, and untwisting rate were measured using two-dimensional speckle-tracking echocardiography.

Results:

Peak endocardial papillary circumferential strain (−21.1 ± 2.6% vs. −25.8 ± 3.8%, p = 0.007), midmyocardial apical circumferential strain (−11.1 ± 4.0% vs. −15.6 ± 3.2%, p = 0.001), epicardial apical circumferential strain (−11.1 ± 4.0% vs. −15.6 ± 3.2%, p = 0.021), and torsion (8.9 ± 6.0 vs. 14.9 ± 4.8 degree, p = 0.021) were significantly lower in the repaired tetralogy of Fallot group than in the control group during exercise, though no significant difference was found between patients and controls at rest.

Conclusions:

Analysis of layer-specific strains and torsion parameters during exercise could detect subclinical left ventricular dysfunction in patients with repaired tetralogy of Fallot, which might reflect potential myocardial damage, at a stage where these parameters have normal values at rest. This finding provides new insight into the mechanisms of cardiac dysfunction in patients with repaired tetralogy of Fallot.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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