Quantification of Right Ventricular Function using Tricuspid and Mitral valve annular descent by Tissue Deformation Imaging in patients with Tetralogy of Fallot

  • James Charlton, University of Southampton, United Kingdom
  • Dr Zaheer Ahmad, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Dr Kevin Roman, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Sheena Toyot, University of Southampton, United Kingdom
  • Dr Zek Lim, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Dr Joseph Vettukattil, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom

    • Objectives
    There are no reproducible and clinically applicable echocardiographic parameters to assess right ventricular (RV) function. We used Tissue Motion Annular Displacement (TMAD) with Speckle Tracking Echocardiography (STE) to quantify RV function.
    METHODS
    Fourteen Tetralogy of Fallot (TOF) patients and 9 controls were enrolled. Images were acquired using Philips iE33 and S5 probe. Apical 4 chamber (AP4) views and mid-level short-axis views were obtained for both patients and controls. Offline analysis was done with QLab 6.0. TMAD was used as a surrogate marker for assessing the longitudinal fibre shortening. Tissue traction points were assigned to the hinge points of the corresponding atrioventricular valve leaflets and ventricular apices. In short-axis view with superimposed colour kinesis, circumferential contraction was assessed from end-diastole to end-systole. Multiple measurements were taken and analysed with SPSS16.
    RESULTS
    Longitudinal shortening of the RV was significantly reduced in TOF patients (17.9+/-2.8vs24.0+/-3.3 p=0.0001). Impairment of the tricuspid valve descent was more pronounced in the RV free wall (15.4+/-3.4vs20.6+/-2.4 p=0.0007) than the interventricular septum (11.9+/-3.1vs12.8+/-2.3 p=0.5). There was a significant difference in longitudinal shortening between the right and left ventricles in controls (24.0+/-3.3vs17.9+/-4.0 p=0.003) and patients with TOF. However, this difference was less pronounced in patients with TOF (17.8+/-2.8vs15.0 +/-4.1 p=0.05). Longitudinal shortening of the left ventricle was not significantly reduced in TOF patients (15.1+/-4.1vs17.9+/-4.0 p=0.1) when compared with the control group.
    CONCLUSION
    RV function can be reliably quantified using STE. Impaired longitudinal shortening seen in TOF predominantly affects the RV free wall while the inter-ventricular septum is spared.