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Cardiac MRI-Derived Myocardial Deformation Parameters Correlate with Pulmonary Valve Replacement Indications in Repaired Tetralogy of Fallot

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Abstract

Right ventricular (RV) volumetric cardiac magnetic resonance (CMR) criteria serve as indicators for pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (rTOF). Myocardial deformation and tricuspid valve displacement parameters may be more sensitive measures of RV dysfunction. This study’s aim was to describe rTOF RV deformation and tricuspid displacement patterns using novel CMR semi-automated software and determine associations with standard CMR measures. Retrospective study of 78 pediatric rTOF patients was compared to 44 normal controls. Global RV longitudinal and circumferential strain and strain rate (SR) and tricuspid valve (TV) displacement were measured. Correlation analysis between strain, SR, TV displacement, and volumes was performed between and within subgroups. The sensitivity and specificity of strain parameters in predicting CMR criteria for PVR was determined. Deformation variables were reduced in rTOF compared to controls. Decreased RV strain and TV shortening were associated with increased RV volumes and decreased RVEF. Longitudinal and circumferential parameters were predictive of RVESVi (> 80 ml/m2) and RVEF (< 47%), with circumferential strain (> − 15.88%) and SR (> − 0.62) being most sensitive. Longitudinal strain was unchanged between rTOF subgroups, while circumferential strain trended abnormal in those meeting PVR criteria compared to controls. RV deformation and TV displacement are abnormal in rTOF, and RV circumferential strain variation may reflect an adaptive response to chronic volume or pressure load. This coupled with associations of ventricular deformation with traditional PVR indications suggest importance of this analysis in the evolution of rTOF RV assessment.

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Availability of Data and Material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code Availability

Not applicable.

Abbreviations

RV:

Right ventricle

TOF:

Tetralogy of Fallot

rTOF:

Repaired tetralogy of Fallot

CMR:

Cardiac magnetic resonance imaging

PVR:

Pulmonary valve replacement

RVEF:

Right ventricular ejection fraction

TV:

Tricuspid valve

LV:

Left ventricular

SR:

Strain rate

ROC:

Receiver operator characteristics

TAPSE:

Tricuspid annular plane systolic excursion

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Acknowledgements

We thank Sevier Canada for funding of the Servier Virtual Cardiac Centre and partial funding of Dr Punithakumar’s employment.

Funding

Servier Canada funded the Servier 3D Virtual Cardiac Centre where part of the research analysis was performed. General funds of the Servier 3D Virtual Cardiac Centre were used to purchase scanning time on a research magnet for the healthy volunteer’s cohort.

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Authors and Affiliations

  1. Stollery Children’s Hospital, Divisions of Pediatric Cardiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada

    Benjamin H. Goot & Edythe B. Tham

  2. Servier Virtual Cardiac Centre, Mazankowski Alberta Heart Institute and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada

    Deepa Krishnaswamy, Kumaradevan Punithakumar & Michelle Noga

  3. Herma Heart Institute, Children’s Wisconsin, Medical College of Wisconsin, 9000 W. Wisconsin Ave., Milwaukee, WI, 53226, USA

    Benjamin H. Goot

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  1. Benjamin H. Goot
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  4. Kumaradevan Punithakumar
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  5. Michelle Noga
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Contributions

MN initiated the study design and obtained ethics approval, collected the normal controls, and analyzed their data. BG collected and analyzed all the CMR data, performed statistical analysis, and prepared the manuscript. KP designed the strain analysis software with continued upgrades of the software to improve tracking. DK provided additional statistical analysis for the strain, multi-variate, L/C ratio, intra-observer, and inter-observer analyses. ET performed the TV displacement analysis, provided additional statistical analysis, and made significant contributions to completing the manuscript including formatting the figures and tables. All authors contributed to revising and approving the final manuscript.

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Correspondence to Benjamin H. Goot.

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The Health Research Ethics Board at the University of Alberta approved this retrospective study. Given the retrospective nature and minimal risk to patients, the need for consent to participate in this study was waived.

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Goot, B.H., Tham, E.B., Krishnaswamy, D. et al. Cardiac MRI-Derived Myocardial Deformation Parameters Correlate with Pulmonary Valve Replacement Indications in Repaired Tetralogy of Fallot. Pediatr Cardiol 42, 1805–1817 (2021). https://doi.org/10.1007/s00246-021-02669-z

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