1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland
Introduction
RV global longitudinal strain (GLS) serves as index variable of RV systolic function. RV systolic dysfunction itself is recognized as an independent prognostic marker of many cardiovascular diseases and outcome. Aim of this study is to assess the phenotype RV strain in the context of various congenital heart diseases and cardiac biomarkers.
Methods
Congenital heart disease was classified into four groups: Ebstein´s anomaly, tetralogy of Fallot (TOF), d-TGA with arterial switch operation (ASO) und systemic RV after atrial switch repair or in double discordance ventricle. Patients with Fontan circulation were excluded. The cardiac biomarkers Nt-proBNP and hsTnT were collected. All patients underwent conventional echocardiography, measuring right and left ventricular dimensions from the apical four-chamber view. RV function was assessed using tricuspid annular plane systolic excursion (TAPSE) and RV fractional are change (FAC). The recommendations of the European Association of Echocardiography were used for the assessment of valvular stenosis and regurgitation. Using speckle-tracking echocardiography, we analyzed longitudinal strain, and compared findings in the patients groups with clinical parameters.
Results
The median age of individuals was 40.0 years, 48.5% were men. In total, 204 patients were included in this study; 31 patients with Ebstein´s anomaly, 94 patients with TOF, 44 patients with systemic right ventricle and 35 patients with d-TGA with ASO.
In the echocardiographic measurements we observed a lower RV GLS, RV freewall longitudinal strain and FAC in all ACHD subgroups compared with the d-TGA cohort. (Table 1). Correlation between cardiac biomarkers and right ventricular echocardiographic parameters were statistically significant (Table 2).
Conclusion
Global longitudinal strain of the systemic RV in patients is lower than GLS of patients with other congenital heart disease. Decreased GLS was associated with elevated NT-proBNP and hsTnT as markers of volume load and myocardial injury. Since RV GLS correlates with RV function, myocardial deformation is useful as a more quantitative tool to measure systemic RV function.
Table 1 Echocardiographic findings were described with median values for continuous variables (25th, 75th percentile) and proportional for categorical variables. Groups were compared respectively by Kruskal-Wallis or χ²-Test
| All (N=204) | Ebstein´s Anomaly (N=31) | TOF (N=94) | Systemic RV (N=44) | d-TGA (N=35) | |
| TAPSE (mm) | 17.0 (14.0,20.0) | 22.4 (18.0,26.1) | 16.0 (14.0,18.0) | 14.0 (11.7,17.3) | 18.5 (16.0,20.6) |
| RV GLS (%) | -13.4 (-17.9,-9.3) | -10.6 (-15.5,-7.3) | -14.1 (-18.3,-11.0) | -9.5 (-13.3,-6.8) | -17.7 (-21.9,-13.5) |
| RV FAC (%) | 26.3 (18.0,35.6) | 23.1 (15.2,35.4) | 27.2 (19.3,36.8) | 18.5 (14.5,24.8) | 35.9 (29.0,44.5) |
| RV Freewall (%) | -14.1 (-19.0,-9.8) | -10.1 (-17.3, -5.1) | -14.9 (-19.7,-12,1) | -9.7 (-13.9, -5.2) | -17.2 (-23.9,-14.1) |
| RV EDA (cm2) | 28.1 (21.3,34.6) | 28.4 (20.1,50.1) | 26.6 (21.8,31.9) | 36.4 (29.8,44.7) | 20.0 (17.3,26.6) |
| RV ESA (cm2) | 20.2 (14.5,26.6) | 23.0 (14.1,38.8) | 19.4 (14.8,22.4) | 28.8 (23.7,35.5) | 12.5 (10.7,17.2) |
| Tricuspid regurgitation (%) | 54 (28.3) | 26 (83.9) | 11 (13.4) | 16 (36.4) | 1 (2.9) |
Table 2 Spearman correlations
| RV GLS | P-value | RV FAC | P-value | RV Freewall | P-value | TAPSE | P-value | |
| NT-proBNP | 0.49 | <0.001 | -0.38 | <0.001 | 0.39 | <0.001 | -0.19 | 0.013 |
| hsTnT | 0.28 | <0.001 | -0.20 | <0.01 | 0.26 | <0.001 | -0.16 | 0.044 |
| TAPSE | -0.36 | <0.001 | 0.25 | <0.001 | -0.27 | <0.001 | 1.00 |