Right Ventricular Strain Parameters Correlate with RV Ejection Fraction and Exercise Performance in Adults with Congenital Heart Disease Undergoing MRI

  • Uyen Truong, Children's National Medical Center, United States
  • Karen Kuehl, Children's National Medical Center, United States
  • Craig Sable, Children's National Medical Center, United States
  • Xiaokui Li, Oregon Health Science University, United States
  • Russell Cross, Children's National Medical Center, United States
  • Lowell Frank, Children's National Medical Center, United States
  • David Sahn, Oregon Health Science University, United States

    • Background: Assessment of right ventricular (RV) function plays a critical role in managing adults with congenital heart disease (CHD). We have previously validated vector velocity imaging (VVI) for determining ventricular mechanics on gradient cine MRI images compared to SPAMM tagging. We used VVI in this study to derive information on RV and left ventricular (LV) function and mechanics from cine MRI in patients with CHD.
    Methods: Adults with tetralogy of Fallot (ToF), and d- and l-transposition who underwent cardiac MRI were included. VVI parameters (strain, strain rate, and radial velocity) were obtained from short and long axis cines of the LV and RV. VVI parameters were compared by linear regression to RV end-diastolic volume, MRI ejection fraction (EF), and VO2 Max on exercise stress test.
    Results: VVI data were available for the LV in 26 and for the RV in 30 patients. MRI RV EF correlated with RV short axis radial strain (r = 0.57, p = 0.005, figure) and strain rate (r = 0.57, p = 0.004). VO2 max correlated with RV radial velocity (r = 0.76, p <0.001) and strain rate (r = 0.45, p = 0.08). LV long axis circumferential strain, radial displacement, and radial strain rate correlated with both MRI LV and RV EF in ToF.
    Conclusions: VVI analysis of gradient cine MRI images is a promising technique in assessing RV function and ventricular-ventricular interaction in adults with CHD affecting the right ventricle. RVEF on MRI could be predictive of both RV and LV strain mechanics.