Speckle Tracking Echocardiography before and after Surgical Pulmonary Valve Replacement in Tetralogy of Fallot Patients: Can STE Elucidate Early Left Ventricular Dysfunction?

AUTHORS

Gholamhossein Ajami ORCID 1 , Fathi Alvasabi 1 , Nima Mehdizadegan ORCID 1 , Mohammadreza Edraki ORCID 1 , Hamid Mohammadi ORCID 1 , * , Ahmad Amirghofran ORCID 2 , Bahram Ghasemzade ORCID 2 , Kambiz Keshavarz ORCID 3 , Hamid Amoozgar ORCID 3 , Hamid Arabi ORCID 3 , Amir Naghshzan ORCID 1 , Mohammad Borzoee 1 , Farah Peiravian ORCID 4

1 Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran

2 Department of Thoracic and Cardiovascular Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran

3 Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, IR Iran

4 Department of Pediatrics, Kazerun branch, Islamic Azad University, Kazerun, IR Iran

How to Cite: Ajami G, Alvasabi F, Mehdizadegan N, Edraki M, Mohammadi H, et al. Speckle Tracking Echocardiography before and after Surgical Pulmonary Valve Replacement in Tetralogy of Fallot Patients: Can STE Elucidate Early Left Ventricular Dysfunction?, Int Cardio Res J. 2020 ; 14(3):e103318.

ARTICLE INFORMATION

International Cardiovascular Research Journal: 14 (3); e103318
Published Online: September 01, 2020
Article Type: Research Article
Received: April 02, 2020
Accepted: August 10, 2020
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Abstract

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart
disease. Most studies have focused on Right Ventricular (RV) dysfunction, while the left
ventricle has received less attention in patients with TOF.
Objective: This study aimed to investigate the Left Ventricular (LV) function after
surgical Pulmonary Valve Replacement (sPVR) in patients with repaired TOF (rTOF) by
Speckle Tracking Echocardiography (STE).
Methods: This single-center, observational, cross-sectional study was conducted on
58 volunteers (age: 15 - 31 years) divided into three groups as follows: 22 PVR patients
(mean age: 18.96 ± 7 year), 16 patients with rTOF, and 20 healthy controls who were
matched regarding the PVR age range. 2D echocardiography (including Doppler and
M-Mode indices of the right and left ventricles) and Speckle Tracking Echocardiography
(STE) (Global Longitudinal Strains (GLS) and 18 segment analyses) were performed for
all patients. All analyses were done using the SPSS software and P < 0.05 was considered
to be statistically significant.
Results: 2D echocardiography showed normal LV Ejection Fraction (LVEF) in all
study groups (64% in sPVR, 60% in rTOF (P = 0.127), and 62.5% in the control group).
However, the mean GLS of the left ventricle significantly reduced in both sPVR (-17.5 ±
2.5%) and rTOF (-17.1 ± 4.7%) patients in comparison to the control group (-20.2 ± 0.7%)
(P = 0.003). Yet, no significant difference was observed between the rTOF and sPVR
groups regarding the GLS (P = 0.9).
Segmental analysis of the Longitudinal Strain (LS) indicated a significant decrease in the
sPVR and rTOF groups in basal anterior, basal septal, basal anterolateral, mid-anterior,
and anterolateral segments. Except for the lower LS in the apical-anteroseptal segment,
this level was mostly spared in both sPVR and rTOF patients.
Conclusion: LVEF was within the normal range among the sPVR patients, but the
pattern of impaired segmental LS and GLS did not change compared to the rTOF
group. In conclusion, sPVR might not have a significant effect on the improvement of
LV function assessed by STE in patients with rTOF. LV damage occurring during the
surgical correction of TOF might have a permanent deteriorating effect on LV function.

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References

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