Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot

Background—Right bundle branch block and right ventricular (RV) dysfunction are common after tetralogy of Fallot repair (rTOF). We hypothesized that right bundle branch block is associated with specific RV mechanical dyssynchrony and inefficient contraction. Methods and Results—We studied rTOF child...

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Authors: Bijnens, Bart, Hui, Wei, Slorach, Cameron, Dragulescu, Andreea, Mertens, Luc, Friedberg, Mark K.
Format: article
Status:Versión aceptada para publicación
Publication Date:2014
Country:España
Institution:Universitat Pompeu Fabra
Repository:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/28222
Online Access:http://hdl.handle.net/10230/28222
http://dx.doi.org/10.1161/CIRCIMAGING.113.001483
Access Level:Open access
Keyword:Bundle-branch block
Heart ventricles
Tetralogy of Fallot
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oai_identifier_str oai:repositori.upf.edu:10230/28222
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spelling Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of FallotBijnens, BartHui, WeiSlorach, CameronDragulescu, AndreeaMertens, LucFriedberg, Mark K.Bundle-branch blockHeart ventriclesTetralogy of FallotBackground—Right bundle branch block and right ventricular (RV) dysfunction are common after tetralogy of Fallot repair (rTOF). We hypothesized that right bundle branch block is associated with specific RV mechanical dyssynchrony and inefficient contraction. Methods and Results—We studied rTOF children and age-matched controls. QRS duration and morphology were assessed. RV mechanical dyssynchrony, indicated by early septal activation (right-sided septal flash), RV lateral wall prestretch/late contraction, postsystolic shortening, and intraventricular delay were analyzed using 2-dimensional strain echocardiography. Peak oxygen consumption reflected exercise capacity. Pulmonary regurgitation and RV volumes were assessed by MRI. Forty-six rTOF patients and 46 controls were studied. Ninety-three percent of rTOF patients demonstrated a right-sided septal flash with simultaneous RV basal lateral wall prestretch/late activation. The RV basal segment was the most delayed in onset (115 [0–194] versus 35 [0–96] ms) and termination (462 [369–706] versus 412 [325–529] ms) of longitudinal shortening, with postsystolic shortening. QRS duration correlated with RV basal time to onset and peak shortening (P<0.05). Intra-RV delay was higher in rTOF (P<0.05) in association with RV dilatation (r=0.33; P=0.04). In rTOF, RV mechanics were inefficient, with prestretch and postsystolic shortening comprising 15±11% and 16±9% of total shortening, respectively. A composite parameter of electric and mechanical dyssynchrony correlated with RV end-diastolic volume (r=0.39; P=0.03). Conclusions—Typical electromechanical dyssynchrony associated with mechanical inefficiency, regional dysfunction, and RV dilatation is common in rTOF children, possibly contributing to progressive RV dysfunction. The potential of cardiac resynchronization in appropriate patients requires further study.American Hearth Association201720172014info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/28222http://dx.doi.org/10.1161/CIRCIMAGING.113.001483reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésCirculation: Cardiovascular Imaging. 2014;7(4):610-18.© American Hearth Association http://dx.doi.org/10.1161/CIRCIMAGING.113.001483info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/282222026-06-12T07:21:37Z
dc.title.none.fl_str_mv Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot
title Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot
spellingShingle Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot
Bijnens, Bart
Bundle-branch block
Heart ventricles
Tetralogy of Fallot
title_short Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot
title_full Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot
title_fullStr Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot
title_full_unstemmed Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot
title_sort Mechanisms of right ventricular electromechanical dyssynchrony and mechanical inefficiency in children after repair of Tetralogy of Fallot
dc.creator.none.fl_str_mv Bijnens, Bart
Hui, Wei
Slorach, Cameron
Dragulescu, Andreea
Mertens, Luc
Friedberg, Mark K.
author Bijnens, Bart
author_facet Bijnens, Bart
Hui, Wei
Slorach, Cameron
Dragulescu, Andreea
Mertens, Luc
Friedberg, Mark K.
author_role author
author2 Hui, Wei
Slorach, Cameron
Dragulescu, Andreea
Mertens, Luc
Friedberg, Mark K.
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Bundle-branch block
Heart ventricles
Tetralogy of Fallot
topic Bundle-branch block
Heart ventricles
Tetralogy of Fallot
description Background—Right bundle branch block and right ventricular (RV) dysfunction are common after tetralogy of Fallot repair (rTOF). We hypothesized that right bundle branch block is associated with specific RV mechanical dyssynchrony and inefficient contraction. Methods and Results—We studied rTOF children and age-matched controls. QRS duration and morphology were assessed. RV mechanical dyssynchrony, indicated by early septal activation (right-sided septal flash), RV lateral wall prestretch/late contraction, postsystolic shortening, and intraventricular delay were analyzed using 2-dimensional strain echocardiography. Peak oxygen consumption reflected exercise capacity. Pulmonary regurgitation and RV volumes were assessed by MRI. Forty-six rTOF patients and 46 controls were studied. Ninety-three percent of rTOF patients demonstrated a right-sided septal flash with simultaneous RV basal lateral wall prestretch/late activation. The RV basal segment was the most delayed in onset (115 [0–194] versus 35 [0–96] ms) and termination (462 [369–706] versus 412 [325–529] ms) of longitudinal shortening, with postsystolic shortening. QRS duration correlated with RV basal time to onset and peak shortening (P<0.05). Intra-RV delay was higher in rTOF (P<0.05) in association with RV dilatation (r=0.33; P=0.04). In rTOF, RV mechanics were inefficient, with prestretch and postsystolic shortening comprising 15±11% and 16±9% of total shortening, respectively. A composite parameter of electric and mechanical dyssynchrony correlated with RV end-diastolic volume (r=0.39; P=0.03). Conclusions—Typical electromechanical dyssynchrony associated with mechanical inefficiency, regional dysfunction, and RV dilatation is common in rTOF children, possibly contributing to progressive RV dysfunction. The potential of cardiac resynchronization in appropriate patients requires further study.
publishDate 2014
dc.date.none.fl_str_mv 2014
2017
2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/28222
http://dx.doi.org/10.1161/CIRCIMAGING.113.001483
url http://hdl.handle.net/10230/28222
http://dx.doi.org/10.1161/CIRCIMAGING.113.001483
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Circulation: Cardiovascular Imaging. 2014;7(4):610-18.
dc.rights.none.fl_str_mv © American Hearth Association http://dx.doi.org/10.1161/CIRCIMAGING.113.001483
info:eu-repo/semantics/openAccess
rights_invalid_str_mv © American Hearth Association http://dx.doi.org/10.1161/CIRCIMAGING.113.001483
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv American Hearth Association
publisher.none.fl_str_mv American Hearth Association
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.811543

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