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Impairment of left atrial function in pediatric patients with repaired tetralogy of Fallot: a cardiovascular magnetic resonance imaging study

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Abstract

We aimed to assess left atrial (LA) strain before LA dilatation in patients with repaired tetralogy of Fallot (rTOF) compared with healthy controls. We also determined the effects of right atrial (RA) dilatation on LA performance using cardiovascular magnetic resonance-feature tracking (CMR-FT). Forty-nine pediatric patients with rTOF and 36 age- and sex-matched healthy controls were prospectively recruited between June 2017 and August 2019. Balanced steady-state free precession (2D b-SSFP) cine, 2D late gadolinium enhancement (LGE) and phase-contrast (PC) sequences were acquired on 1.5 and 3.0 Tesla scanners. Both ventricular and atrial volumes and ejection fraction were measured. Left ventricular (LV) strain and diastolic strain rates were evaluated between the rTOF patient and control groups. LA reservoir (Ɛs), conduit (Ɛe), and booster strain (Ɛa) were determined at LV end-systole, LV diastasis, and pre-LA systole, respectively. The first derivatives of the respective strains yielded corresponding peak strain rates. Statistical analysis was performed using the t-test and Mann–Whitney test for parametric and non-parametric variables, respectively. Correlations were assessed using Pearson’s correlation coefficient for normally distributed variables and Spearman’s correlation coefficient for non-parametric data. Intra-observer and inter-observer variabilities of LA strain and strain rate measurements were determined from ten randomly selected rTOF patients and ten control subjects. LA strain was significantly lower in patients with rTOF compared with controls (Ɛs, P < 0.001; Ɛe, P = 0.002; Ɛa, P < 0.001). The correlations between LA strain and RA stroke volume indices (SVi) and RA ejection fraction (EF) were moderate (Ɛs and SVi, r = 0.538, P < 0.001; Ɛs and RA EF, r = 0.493, P < 0.001; Ɛe and SVi, r = 0.532, P < 0.001; Ɛe and RA EF, r = 0.466, P < 0.001). LA strain and strain rates had good reproducibility in intra-observer and inter-observer analyses. LA strain and strain rates decreased in pediatric patients with rTOF compared with controls before LA enlargement. A dysfunction in LA performance might precede LV dysfunction in patients with rTOF, even in the early stages after repair.

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Abbreviations

CMR:

Cardiovascular magnetic resonance

LA:

Left atrial

FT:

Feature tracking

PR:

Pulmonary regurgitation

rTOF:

Repaired tetralogy of Fallot

RV:

Right ventricular

LV:

Left ventricular

RA:

Right atrial

PC:

Phase contrast

LGE:

Late gadolinium enhancement

EDV:

End-diastolic volume

ESV:

End-systolic volume

SV:

Stroke volume

EF:

Ejection fraction

CO:

Cardiac output

BSA:

Body surface area

LAV:

LA volume

LAVmax:

LAV was assessed at LV end-systole

LAVpre-a:

LAV was assessed at LV diastole before LA contraction

LAVmin:

LAV was assessed at late LV diastole after LA contraction

MPA:

Main pulmonary artery

AAO:

Ascending aorta

SR:

Strain rate

GRS:

Global radial strain

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GDRSR:

Global diastole radial strain rate

GDCSR:

Global diastole circumferential strain rate

GDLSR:

Global diastole longitudinal strain rate

Ɛs:

Reservoir strain

Ɛe:

Conduit strain

Ɛa:

Booster strain

SRs:

Peak positive strain rate

SRe:

Peak early negative strain rate

SRa:

Peak late negative strain rate

ICC:

Intraclass correlation coefficient

COV:

Coefficient of variation

ASD:

Atrial septal defect

PDA:

Patent ductus arteriosus

References

  1. Kowallick JT, Kutty S, Edelmann F et al (2014) Quantification of left atrial strain and strain rate using cardiovascular magnetic resonance myocardial feature tracking: a feasibility study. J Cardiovasc Magn Reson 16:60

    Article  Google Scholar 

  2. Leng S, Tan RS, Zhao XD et al (2018) Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 20:71

    Article  Google Scholar 

  3. Schuster A, Backhaus SJ, Stiermaier T et al (2019) Left atrial function with MRI enables prediction of cardiovascular events after myocardial Infarction: insights from the AIDA STEMI and TATORT NSTEMI trials. Radiology 293(2):292–302

    Article  Google Scholar 

  4. Matthias A, Marius K, Sebastian G et al (2016) Left ventricular mechanics assessed by two-dimensional echocardiography and cardiac magnetic resonance imaging: comparison of high-resolution speckle tracking and feature tracking. Eur Heart J Cardiovasc Imaging 17(12):1370–1378

    Article  Google Scholar 

  5. Pathan F, Zainal Abidin HA, Vo QH et al (2019) Left atrial strain: a multi-modality, multi-vendor comparison study. Eur Heart J Cardiovasc Imaging 22:102–110

    Article  Google Scholar 

  6. Ghelani Sunil J, Brown David W, Kuebler Joseph D et al (2018) left atrial volumes and strain in healthy children measured by three-dimensional echocardiography: normal values and maturational changes. J Am Soc Echocardiogr 31(2):187–193

    Article  CAS  Google Scholar 

  7. Truong VT, Palmer C, Wolking S et al (2020) Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur Heart J Cardiovasc Imaging 21(4):446–453

    PubMed  Google Scholar 

  8. Gnanappa GK, Celermajer DS, Zhu D et al (2019) Severe right ventricular dilatation after repair of Tetralogy of Fallot is associated with increased left ventricular preload and stroke volume. Eur Heart J Cardiovasc Imaging 20(9):1020–1026

    Article  Google Scholar 

  9. Kempny A, Diller GP, Orwat S et al (2012) Right ventricular–left ventricular interaction in adults with Tetralogy of Fallot: a combined cardiac magnetic resonance and echocardiographic speckle tracking study. Int J Cardiol 154(3):259–264

    Article  Google Scholar 

  10. Lamia AA, Philipp L, Andrea R et al (2019) Implications of atrial volumes in surgical corrected Tetralogy of Fallot on clinical adverse events. Int J Cardiol 283:107–111

    Article  Google Scholar 

  11. Stokke TM, Hasselberg NE, Smedsrud MK et al (2017) Geometry as a confounder when assessing ventricular systolic function: comparison between ejection fraction and strain. J Am Coll Cardiol 70(8):942–954

    Article  Google Scholar 

  12. Kutty S, Shang Q, Joseph N et al (2017) Abnormal right atrial performance in repaired tetralogy of Fallot: a CMR feature tracking analysis. Int J Cardiol 248:136–142

    Article  Google Scholar 

  13. Gaasch WH, Zile MR (2011) Left ventricular structural remodeling in health and disease: with special emphasis on volume, mass, and geometry. J Am Coll Cardiol 58(17):1733–1740

    Article  Google Scholar 

  14. Shuang L, Yang D, Yang W et al (2019) Impaired cardiovascular magnetic resonance-derived rapid semiautomated right atrial longitudinal strain is associated with decompensated hemodynamics in pulmonary arterial hypertension. Circulation 12:e008582

    Google Scholar 

  15. Eugénie R, Lena M, Matthias M et al (2010) Integrated analysis of atrioventricular interactions in tetralogy of Fallot. Am J Physiol Heart Circ Physiol 299(2):H364-371

    Article  CAS  Google Scholar 

  16. Yiu-Fai C, Yu Clement KM, Edwina KFS et al (2019) Atrial strain imaging after repair of tetralogy of Fallot: a systematic review. Ultrasound Med Biol 45(8):1896–1908

    Article  Google Scholar 

  17. Cristina AA, Michael JH, Philip W et al (2019) Determinants of left ventricular dysfunction and remodeling in patients with corrected Tetralogy of Fallot. J Am Heart Assoc 8(17):e009618

    Google Scholar 

  18. Baggen Vivan JM, Schut Anne-Rose W, Cuypers Judith AAE et al (2017) Prognostic value of left atrial size and function in adults with tetralogy of Fallot. Int J Cardiol 236:125–131

    Article  CAS  Google Scholar 

  19. Murata M, Iwanaga S, Tamura Y et al (2008) A real-time three-dimensional echocardiographic quantitative analysis of left atrial function in left ventricular diastolic dysfunction. Am J Cardiol 102:1097–1102

    Article  Google Scholar 

  20. Alexander CE, Maria N, Keerthana B et al (2019) Impact of atrial arrhythmia on survival in adults with tetralogy of Fallot. Am Heart J 218:1–7

    Article  Google Scholar 

  21. Hu L, Sun A, Guo C et al (2019) Assessment of global and regional strain left ventricular in patients with preserved ejection fraction after Fontan operation using a tissue tracking technique. Int J Cardiovasc Imaging 35(1):153–160

    Article  Google Scholar 

  22. Li-Wei Hu, Liu X-R, Wang Q et al (2020) Systemic ventricular strain and torsion are predictive of elevated serum NT-proBNP in Fontan patients: a magnetic resonance study. Quant Imaging Med Surg 10(2):485–495

    Article  Google Scholar 

  23. Hagdorn Quint AJ, Vos Johan DL, Beurskens Niek EG et al (2019) CMR feature tracking left ventricular strain-rate predicts ventricular tachyarrhythmia, but not deterioration of ventricular function in patients with repaired tetralogy of Fallot. Int J Cardiol 295:1–6

    Article  CAS  Google Scholar 

  24. Bianco Christopher M, Farjo Peter D, Ghaffar Yasir A et al (2020) Myocardial mechanics in patients with normal LVEF and diastolic dysfunction. JACC Cardiovasc Imaging 13:258–271

    Article  CAS  Google Scholar 

  25. Hou J, Yu HK, Wong SJ, Cheung YF (2015) Atrial mechanics after surgical repair of tetralogy of Fallot. Echocardiography 32(1):126–134

    Article  Google Scholar 

  26. Tammo KJ, Joachim L, Gerd H et al (2015) Left atrial physiology and pathophysiology: Role of deformation imaging. World J Cardiol 7(6):299–305

    Article  Google Scholar 

  27. Hinojar R, Zamorano JL, Fernández-Méndez M, Esteban A, Plaza-Martin M et al (2019) Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 35(6):1055–1065

    Article  Google Scholar 

  28. Yingxia Y, Gang Y, Yong J et al (2020) Quantification of left atrial function in patients with non-obstructive hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking imaging: a feasibility and reproducibility study. J Cardiovasc Magn Reson 22:1

    Article  Google Scholar 

  29. Lamia AA, Gianluca T, Roberto C et al (2016) Left ventricular dysfunction in repaired tetralogy of Fallot: incidence and impact on atrial arrhythmias at long term-follow up. Int J Cardiovasc Imaging 32(9):1441–1449

    Article  Google Scholar 

  30. Hagdorn Quint AJ, Vos Johan DL, Beurskens Niek EG et al (2019) CMR feature tracking left ventricular strain-rate predicts ventricular tachyarrhythmia, but not deterioration of ventricular function in patients with repaired tetralogy of Fallot. Int J Cardiol 291:1–6

    Article  Google Scholar 

  31. Andreas S, Geraint M, Shazia TH et al (2013) The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength. Eur J Radiol 82(2):296–301

    Article  Google Scholar 

Download references

Funding

This study was funded by the National Key R&D Program of China (No. 2018YFB1107100), the Shanghai Committee of Science and Technology (Nos. 17411965400, No.17DZ2253100), and the Shanghai Municipal Commission of Health and Family Planning (No. 201740095). The study was supported by the Shanghai “Rising Stars of Medical Talent” Medical Imaging Practitioner Program.

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Authors and Affiliations

  1. Diagnostic Imaging Center, Shanghai Children’s Medical Center Affiliated With Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People’s Republic of China

    Liwei Hu, Rongzhen Ouyang, Chen Guo, Yafeng Peng, Weihui Xie & Yumin Zhong

  2. Department of Cardiovascular and Thoracic Surgery, Shanghai Children’s Medical Center Affiliated With Shanghai, Jiao Tong University School of Medicine, No. 1678 Dong Fang Road, Shanghai, 200127, China

    Xinlong Liu & Yumin Zhong

  3. National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore

    Leng Shuang, Zhao Xiaodan & Zhong Liang

  4. Duke-NUS Medical School, National University of Singapore, 8 College Rd., Singapore, 169857, Singapore

    Leng Shuang, Zhao Xiaodan & Zhong Liang

  5. Circle Cardiovascular Imaging, 250, 815 8th Ave SW, Calgary, Canada

    Tongtong Han

Authors
  1. Liwei Hu
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  2. Rongzhen Ouyang
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  3. Xinlong Liu
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  4. Leng Shuang
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  10. Zhong Liang
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  11. Yumin Zhong
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Contributions

All authors made appropriate contributions to the manuscript. LWH, ZL and YMZ were involved in the study design. LWH and YMZ drafted the manuscript. RZO, PYF, and WHX participated in data acquisition. LWH, XL, ZXD, CG, and LS were involved in data analysis. LWH and TTH performed the statistical analysis. All authors critically reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Zhong Liang or Yumin Zhong.

Ethics declarations

Informed consent

All participants were prospectively evaluated in this study with local approval from the Medical Ethical Committee of the Shanghai Children’s Medical Center (SCMCIRB-K2017062). Informed consent was obtained from all participants. All methods were performed in accordance with the relevant guidelines and regulations.

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Hu, L., Ouyang, R., Liu, X. et al. Impairment of left atrial function in pediatric patients with repaired tetralogy of Fallot: a cardiovascular magnetic resonance imaging study. Int J Cardiovasc Imaging 37, 3255–3267 (2021). https://doi.org/10.1007/s10554-021-02302-3

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  • DOI: https://doi.org/10.1007/s10554-021-02302-3

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