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Functional implications of the right ventricular myocardial performance index in patients after surgical repair of tetralogy of Fallot

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Abstract

The myocardial performance index (MPI) has been proposed to be a simple echocardiographic index of right ventricular (RV) function in patients after surgical repair of tetralogy of Fallot (TOF). However, its functional status remains to be clarified. The functional implications of RV MPI were determined by exploring its relationships with parameters of RV function as derived from cardiovascular magnetic resonance (CMR), and exercise capacity of postoperative TOF patients Thirty patients (11 males), aged 15.6 ± 3.1 years, who have undergone surgical repair of TOF at 4.0 ± 1.8 years, were studied. The RV and left ventricular (LV) MPIs determined using pulsed-wave Doppler echocardiography were related to CMR-derived RV and LV ejection fractions, and pulmonary regurgitant fraction and treadmill exercise testing parameters. Log RV MPI correlated positively with log LV MPI (r = 0.38, P = 0.037) and negatively with CMR-derived RV ejection fraction (r = −0.4, P = 0.028) and pulmonary regurgitant fraction (r = −0.4, P = 0.031). No significant correlations were found between LV MPI and any of the CMR parameters. Using receiver operated characteristics analysis, a cutoff value of 0.30 for RV MPI was found to have a sensitivity of 100% and specificity of 74% in predicting a RV ejection fraction <35%. Right ventricular, but not LV, MPI correlated inversely with exercise duration (r = −0.45, P = 0.013) and peak oxygen consumption (VO2 max) (r = −0.56, P = 0.001). Multivariate analysis identified RV MPI (β = −0.6, P < 0.001), male sex (β = 0.44, P = 0.01), and duration from surgery (β = −0.30, P = 0.019) as significant determinants of VO2 max. Increased MPI is a reflection of reduced RV ejection fraction and exercise capacity in patients after TOF repair.

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References

  1. Davlouros PA, Kilner PJ, Homung TS, Li W, Francis JM, Moon JCC, Smith GC, Tat T, Pennel DJ, Gatzoulis MA (2002) Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 40:2044–2052

    Article  PubMed  Google Scholar 

  2. Uebing A, Fisher G, Bethge M, Scheewe J, Schmiel F, Stieh J, Brossmann J, Kramer HH (2002) Influence of the pulmonary annulus diameter on pulmonary regurgitation and right ventricular pressure load after repair of tetralogy of Fallot. Heart 88:510–514

    Article  PubMed  CAS  Google Scholar 

  3. Gatzoulis MA, Elliott JT, Guru V, Siu SC, Warsi MA, Webb G, Williams WG, Liu P, McLaughlin PR (2000) Right and left ventricular systolic function late after repair of tetralogy of Fallot. Am J Cardiol 86:1352–1357

    Article  PubMed  CAS  Google Scholar 

  4. Lim C, Lee JY, Kim WH, Kim SC, Song JY, Kim SJ, Choh JH, Kim CW (2004) Early replacement of pulmonary valve after repair of tetralogy: is it really beneficial? Eur J Cardiothorac Surg 25: 728–734

    Article  PubMed  Google Scholar 

  5. Therrien J, Provost Y, Merchant N, Williams W, Colman J, Webb G (2005) Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair. Am J Cardiol 95:779–782

    Article  PubMed  Google Scholar 

  6. Khambadkone S, Coats L, Taylor A, Boudjemline Y, Derrick G, Tsang V, Cooper J, Muthurangu V, Hegde SR, Razavi RS, Pellerin D, Deanfield J, Bonhoeffer P (2005) Percutaneous pulmonary valve implantation in humans: results in 59 consecutive patients. Circulation 112:1189–1197

    Article  PubMed  Google Scholar 

  7. Eyskens B, Reybrouck T, Bogaert J, Dymarkowsky S, Daenen W, Dumoulin M, Gewilling M (2000) Homograft insertion for pulmonary regurgitation after repair of tetralogy of Fallot improves cardiorespiratory exercise performance. Am J Cardiol 85:221–225

    Article  PubMed  CAS  Google Scholar 

  8. Therrien J, Siu SC, Harris L, Dore A, Niwa K, Janousek J, Williams WG, Webb G, Gatzoulis MA (2001) Impact of pulmonary valve replacement on arrhythmia propensity late after repair of tetralogy of Fallot. Circulation 103:2489–2494

    PubMed  CAS  Google Scholar 

  9. Helbing WA, de Roos A (2000) Clinical applications of cardiac magnetic resonance imaging after repair of tetralogy of Fallot. Pediatr Cardiol 21:70–90

    Article  PubMed  CAS  Google Scholar 

  10. Rebergen SA, Chin JG, Ottenkamp J, van der Wall EE, de Roos A (1993) Pullmonary regurgitation in the late postoperative follow-up of tetralogy of Fallot: volumetric quantification by nuclear magnetic resonance velocity mapping. Circulation 88:2257–2266

    PubMed  CAS  Google Scholar 

  11. Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskischivili V, Gutberlet M, Hetzer R, Lange PE (2002) Value of new Doppler-derived myocardial performance index for the evaluation of right and left ventricular function following repair of tetralogy of Fallot. Pediatr Cardiol 23:502–507

    Article  PubMed  CAS  Google Scholar 

  12. Norozi K, Buchhom R, Barmus D, Alpers V, Amhold JO, Schoof S, Zoege M, Binder L, Geyer S, Wessel A (2006) Elevated brain natriuretic peptide and reduced exercise capacity in adult patients operated on for tetralogy of Fallot is due to biventricular dysfunction as determined by the myocardial performance index. Am J Cardiol 97:1377–1382

    Article  PubMed  CAS  Google Scholar 

  13. Bruns LA, Christant MK, Lamour MJ, Shaddy RE, Pahl E, Blume ED, Hallowell S, Addonizio LJ, Canter CE (2001) Carvedilol as therapy in pediatric heart failure: an initial multicenter experience. J Pediatr 138:505–511

    Article  PubMed  CAS  Google Scholar 

  14. Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik MD, Seward SB (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 13:838–847

    Google Scholar 

  15. Dayi SU, Kasikcioglu H, Uslu N, Tartan Z, Uyarel H, Terzi S, Hobikoglu G, Okmen E, Cam N (2006) Influence of weight loss on myocardial performance index. Heart Vessels 21:84–88

    Article  PubMed  Google Scholar 

  16. Silversides CK, Veldman GR, Crossin J, Merchant N, Webb GD, McCrindle BW, Siu SC, Therrien J (2003) Pressure half-time predicts hemodynamically significant pulmonary regurgitation in adult patients with repaired tetralogy of Fallot. J Am Soc Echocardiogr 16:1057–1062

    Article  PubMed  Google Scholar 

  17. Bruce RA (1971) Exercise testing of patients with coronary heart disease. Ann Clin Res 3:323–330

    PubMed  CAS  Google Scholar 

  18. Moller JE, Poulsen SH, Egstrup K (1999) Effect of preload alterations on a new Doppler echocardiographic index of combined systolic and diastolic performance. J Am Soc Echocardiogr 135:1065–1072

    Google Scholar 

  19. Cheung MMH, Smallhorn JF, Redington AN, Vogel M (2004) The effects of changes in loading conditions and modulation of inotropic state on the myocardial performance index: comparison with conductance catheter measurements. Eur Heart J 25:2238–2242

    Article  PubMed  Google Scholar 

  20. Gatzoulis MA, Clark AL, Cullen S, Newman CG, Redington AN (1995) Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot: restrictive physiology predicts superior exercise performance. Circulation 91:1775–1781

    PubMed  CAS  Google Scholar 

  21. Ishii M, Eto G, Tei C, Tsutsumi T, Hashino K, Sugahara Y, Himeno W, Muta H, Furui J, Akagi T, Fukiyama R, Toyoda O, Kato H (2000) Quantitation of the global right ventricular function in children with normal heart and congenital heart disease: a right ventricular myocardial performance index. Pediatr Cardiol 21:416–421

    Article  PubMed  CAS  Google Scholar 

  22. Eidem BW, O’Leary PW, Tei C, Seward JB (2000) Usefulness of the myocardial performance index for assessing right ventricular function in congenital heart disease. Am J Cardiol 86:654–658

    Article  PubMed  CAS  Google Scholar 

  23. Salehian O, Schwerzmann M, Merchant N, Webb GD, Siu SC, Therrien J (2004) Assessment of systemic right ventricular function in patients with transposition of great arteries using the myocardial performance index: comparison with cardiac magnetic resonance imaging. Circulation 110:3329–3233

    Article  Google Scholar 

  24. Cheung EWY, Lam WWM, Chiu CSW, Chau AKT, Cheung SCW, Cheung YF (2007) Plasma brain natriuretics peptide levels, right ventricular volume overload and exercise capacity in adolescents after surgical repair of tetralogy of Fallot, Int J Cardiol 121: 155–162

    Article  PubMed  Google Scholar 

  25. Kasikcioglu E, Olfaz H, Akhan H, Kayserilioglu A (2005) Right ventricular myocardial performance index and exercise capacity in athletes. Heart Vessels 20:147–152

    Article  PubMed  Google Scholar 

  26. Norozi K, Buchhorn R, Alpers V, Arnhold JO, Schoof S, Zoege M, Geyer S, Wessel A (2005) Relation of systemic ventricular function quantified by myocardial performance index (Tei) to cardiopulmonary exercise capacity in adults after mustard procedure for transposition of the great arteries. Am J Cardiol 96:1721–1725

    Article  PubMed  Google Scholar 

  27. Schwerzmann M, Samman AM, Salehian O, Holm J, Provost Y, Webb GD, Therrien J, Siu SC, Silversides CK (2007) Comparison of echocardiographic and cardiac magnetic resonance imaging for assessing right ventricular function in adults with repaired tetralogy of Fallot. Am J Cardiol 99:1593–1597

    Article  PubMed  Google Scholar 

  28. Kim WH, Otsuji Y, Yuasa T, Minagoe S, Seward JB, Tei C (2004) Evaluation of right ventricular dysfunction in patients with cardiac amyloidosis using Tei index. J Am Soc Echocardiogr 17:45–49

    Article  PubMed  Google Scholar 

  29. Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004) Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43:1068–1074

    Article  PubMed  Google Scholar 

  30. Babu-Narayan SV, Kilner PJ, Li W, Moon JC, Goktekin O, Davlouros PA, Khan M, Ho SY, Pennell DJ, Gatzoulis MA (2006) Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of Fallot and its relationship to adverse markers of clinical outcome. Circulation 113:405–413

    Article  PubMed  CAS  Google Scholar 

  31. Yetman AT, Lee KJ, Hamilton R, Morrow WR, McCrindle BW (2001) Exercise capacity after repair of tetralogy of Fallot in infancy. Am J Cardiol 87:1021–1023

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Grantham Hospital, The University of Hong Kong, 125 Wong Chuk Hang Road, Hong Kong, China

    Eddie W. Y. Cheung & Yiu-fai Cheung

  2. Queen Mary Hospital, Hong Kong, China

    Wendy W. M. Lam & Stephen C. W. Cheung

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  1. Eddie W. Y. Cheung
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  2. Wendy W. M. Lam
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  4. Yiu-fai Cheung
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Correspondence to Yiu-fai Cheung.

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Cheung, E.W.Y., Lam, W.W.M., Cheung, S.C.W. et al. Functional implications of the right ventricular myocardial performance index in patients after surgical repair of tetralogy of Fallot. Heart Vessels 23, 112–117 (2008). https://doi.org/10.1007/s00380-007-1016-7

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  • DOI: https://doi.org/10.1007/s00380-007-1016-7

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