Right Ventricular Mechanics and QRS Duration in Patients With Repaired Tetralogy of Fallot Implications of Infundibular Disease
Background— Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be candidates for cardiac resynchronization therapy. We aimed to assess the relationship between QRSd and the timing of RV wall motion, i...
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| Published in | Circulation (New York, N.Y.) Vol. 116; no. 14; pp. 1532 - 1539 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
Lippincott Williams & Wilkins
02.10.2007
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-7322 1524-4539 1524-4539 |
| DOI | 10.1161/CIRCULATIONAHA.107.688770 |
Cover
| Abstract | Background—
Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be candidates for cardiac resynchronization therapy. We aimed to assess the relationship between QRSd and the timing of RV wall motion, including the RV outflow tract (RVOT), in these patients.
Methods and Results—
Sixty-seven repaired ToF patients (median age, 34 years; interquartile range, 24 to 43 years) and 35 age-matched control subjects were studied by echocardiography and cardiovascular magnetic resonance (n=55 of 67 ToF patients). Time intervals of the RV cardiac cycle were measured from Doppler recordings. Long-axis M-mode recordings were acquired from the right ventricular (RV) free wall and RV outflow tract (RVOT), and the delay in onset of long-axis shortening was measured. ToF patients showed minor abnormalities of the RV cardiac cycle unrelated to QRSd. RV ejection time was prolonged and correspondingly filling time was reduced compared with control subjects (22.3±2.6 versus 20.0±2.9 s/min,
P
<0.0001; 29.0±3.8 versus 32.7±3.5 s/min,
P
<0.0001). Total isovolumic time was normal in ToF patients (8.7±4.0 versus 7.4±2.9 s/min;
P
=NS). QRSd correlated with the delay in RV free wall motion (
r
=0.55,
P
<0.0001) and more so with the delay in RVOT shortening (
r
=0.82,
P
<0.0001). QRSd also correlated with measures of RVOT abnormality such as long-axis RVOT excursion and akinetic area length (
r
=−0.46,
P
=0.004;
r
=0.33,
P
=0.01).
Conclusions—
QRSd in postoperative ToF patients reflects mainly abnormalities of the RVOT rather than the RV body itself. Thus, prevention and treatment of mechanical asynchrony and malignant arrhythmia should focus on the RV infundibulum. Indications for cardiac resynchronization therapy after ToF repair warrant further investigation. |
|---|---|
| AbstractList | Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be candidates for cardiac resynchronization therapy. We aimed to assess the relationship between QRSd and the timing of RV wall motion, including the RV outflow tract (RVOT), in these patients.
Sixty-seven repaired ToF patients (median age, 34 years; interquartile range, 24 to 43 years) and 35 age-matched control subjects were studied by echocardiography and cardiovascular magnetic resonance (n=55 of 67 ToF patients). Time intervals of the RV cardiac cycle were measured from Doppler recordings. Long-axis M-mode recordings were acquired from the right ventricular (RV) free wall and RV outflow tract (RVOT), and the delay in onset of long-axis shortening was measured. ToF patients showed minor abnormalities of the RV cardiac cycle unrelated to QRSd. RV ejection time was prolonged and correspondingly filling time was reduced compared with control subjects (22.3+/-2.6 versus 20.0+/-2.9 s/min, P<0.0001; 29.0+/-3.8 versus 32.7+/-3.5 s/min, P<0.0001). Total isovolumic time was normal in ToF patients (8.7+/-4.0 versus 7.4+/-2.9 s/min; P=NS). QRSd correlated with the delay in RV free wall motion (r=0.55, P<0.0001) and more so with the delay in RVOT shortening (r=0.82, P<0.0001). QRSd also correlated with measures of RVOT abnormality such as long-axis RVOT excursion and akinetic area length (r=-0.46, P=0.004; r=0.33, P=0.01).
QRSd in postoperative ToF patients reflects mainly abnormalities of the RVOT rather than the RV body itself. Thus, prevention and treatment of mechanical asynchrony and malignant arrhythmia should focus on the RV infundibulum. Indications for cardiac resynchronization therapy after ToF repair warrant further investigation. Background— Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be candidates for cardiac resynchronization therapy. We aimed to assess the relationship between QRSd and the timing of RV wall motion, including the RV outflow tract (RVOT), in these patients. Methods and Results— Sixty-seven repaired ToF patients (median age, 34 years; interquartile range, 24 to 43 years) and 35 age-matched control subjects were studied by echocardiography and cardiovascular magnetic resonance (n=55 of 67 ToF patients). Time intervals of the RV cardiac cycle were measured from Doppler recordings. Long-axis M-mode recordings were acquired from the right ventricular (RV) free wall and RV outflow tract (RVOT), and the delay in onset of long-axis shortening was measured. ToF patients showed minor abnormalities of the RV cardiac cycle unrelated to QRSd. RV ejection time was prolonged and correspondingly filling time was reduced compared with control subjects (22.3±2.6 versus 20.0±2.9 s/min, P <0.0001; 29.0±3.8 versus 32.7±3.5 s/min, P <0.0001). Total isovolumic time was normal in ToF patients (8.7±4.0 versus 7.4±2.9 s/min; P =NS). QRSd correlated with the delay in RV free wall motion ( r =0.55, P <0.0001) and more so with the delay in RVOT shortening ( r =0.82, P <0.0001). QRSd also correlated with measures of RVOT abnormality such as long-axis RVOT excursion and akinetic area length ( r =−0.46, P =0.004; r =0.33, P =0.01). Conclusions— QRSd in postoperative ToF patients reflects mainly abnormalities of the RVOT rather than the RV body itself. Thus, prevention and treatment of mechanical asynchrony and malignant arrhythmia should focus on the RV infundibulum. Indications for cardiac resynchronization therapy after ToF repair warrant further investigation. Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be candidates for cardiac resynchronization therapy. We aimed to assess the relationship between QRSd and the timing of RV wall motion, including the RV outflow tract (RVOT), in these patients.BACKGROUNDPatients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be candidates for cardiac resynchronization therapy. We aimed to assess the relationship between QRSd and the timing of RV wall motion, including the RV outflow tract (RVOT), in these patients.Sixty-seven repaired ToF patients (median age, 34 years; interquartile range, 24 to 43 years) and 35 age-matched control subjects were studied by echocardiography and cardiovascular magnetic resonance (n=55 of 67 ToF patients). Time intervals of the RV cardiac cycle were measured from Doppler recordings. Long-axis M-mode recordings were acquired from the right ventricular (RV) free wall and RV outflow tract (RVOT), and the delay in onset of long-axis shortening was measured. ToF patients showed minor abnormalities of the RV cardiac cycle unrelated to QRSd. RV ejection time was prolonged and correspondingly filling time was reduced compared with control subjects (22.3+/-2.6 versus 20.0+/-2.9 s/min, P<0.0001; 29.0+/-3.8 versus 32.7+/-3.5 s/min, P<0.0001). Total isovolumic time was normal in ToF patients (8.7+/-4.0 versus 7.4+/-2.9 s/min; P=NS). QRSd correlated with the delay in RV free wall motion (r=0.55, P<0.0001) and more so with the delay in RVOT shortening (r=0.82, P<0.0001). QRSd also correlated with measures of RVOT abnormality such as long-axis RVOT excursion and akinetic area length (r=-0.46, P=0.004; r=0.33, P=0.01).METHODS AND RESULTSSixty-seven repaired ToF patients (median age, 34 years; interquartile range, 24 to 43 years) and 35 age-matched control subjects were studied by echocardiography and cardiovascular magnetic resonance (n=55 of 67 ToF patients). Time intervals of the RV cardiac cycle were measured from Doppler recordings. Long-axis M-mode recordings were acquired from the right ventricular (RV) free wall and RV outflow tract (RVOT), and the delay in onset of long-axis shortening was measured. ToF patients showed minor abnormalities of the RV cardiac cycle unrelated to QRSd. RV ejection time was prolonged and correspondingly filling time was reduced compared with control subjects (22.3+/-2.6 versus 20.0+/-2.9 s/min, P<0.0001; 29.0+/-3.8 versus 32.7+/-3.5 s/min, P<0.0001). Total isovolumic time was normal in ToF patients (8.7+/-4.0 versus 7.4+/-2.9 s/min; P=NS). QRSd correlated with the delay in RV free wall motion (r=0.55, P<0.0001) and more so with the delay in RVOT shortening (r=0.82, P<0.0001). QRSd also correlated with measures of RVOT abnormality such as long-axis RVOT excursion and akinetic area length (r=-0.46, P=0.004; r=0.33, P=0.01).QRSd in postoperative ToF patients reflects mainly abnormalities of the RVOT rather than the RV body itself. Thus, prevention and treatment of mechanical asynchrony and malignant arrhythmia should focus on the RV infundibulum. Indications for cardiac resynchronization therapy after ToF repair warrant further investigation.CONCLUSIONSQRSd in postoperative ToF patients reflects mainly abnormalities of the RVOT rather than the RV body itself. Thus, prevention and treatment of mechanical asynchrony and malignant arrhythmia should focus on the RV infundibulum. Indications for cardiac resynchronization therapy after ToF repair warrant further investigation. |
| Author | Babu-Narayan, Sonya V. Diller, Gerhard P. Uebing, Anselm Spence, Mark S. Henein, Michael Y. Gatzoulis, Michael A. Goktekin, Omer Andersen, Kai Li, Wei Gibson, Derek G. Dimopoulos, Konstantinos |
| Author_xml | – sequence: 1 givenname: Anselm surname: Uebing fullname: Uebing, Anselm organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 2 givenname: Derek G. surname: Gibson fullname: Gibson, Derek G. organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 3 givenname: Sonya V. surname: Babu-Narayan fullname: Babu-Narayan, Sonya V. organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 4 givenname: Gerhard P. surname: Diller fullname: Diller, Gerhard P. organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 5 givenname: Konstantinos surname: Dimopoulos fullname: Dimopoulos, Konstantinos organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 6 givenname: Omer surname: Goktekin fullname: Goktekin, Omer organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 7 givenname: Mark S. surname: Spence fullname: Spence, Mark S. organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 8 givenname: Kai surname: Andersen fullname: Andersen, Kai organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 9 givenname: Michael Y. surname: Henein fullname: Henein, Michael Y. organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 10 givenname: Michael A. surname: Gatzoulis fullname: Gatzoulis, Michael A. organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein – sequence: 11 givenname: Wei surname: Li fullname: Li, Wei organization: From the Adult Congenital Heart Disease Centre and Centre for Pulmonary Hypertension (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.), Department of Echocardiography (D.G.G., M.Y.H.), and Cardiac Magnetic Resonance Unit (S.V.B.-N.), Royal Brompton Hospital, London, UK; National Heart and Lung Institute at Imperial College, London, UK (A.U., S.V.B.-N., G.P.D., K.D., O.G., M.S.S., K.A., M.A.G., W.L.); and Department of Pediatric Cardiology, University Hospital of Schleswig-Holstein |
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| Issue | 14 |
| Keywords | Human right ventricular mechanics Treatment cardiac resynchronization therapy Heart disease Fallot tetralogy Cardiovascular disease QRS duration tetralogy of Fallot Congenital disease |
| Language | English |
| License | CC BY 4.0 |
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| PublicationTitle | Circulation (New York, N.Y.) |
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| PublicationYear | 2007 |
| Publisher | Lippincott Williams & Wilkins |
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| References | e_1_3_2_26_2 e_1_3_2_27_2 e_1_3_2_28_2 e_1_3_2_29_2 e_1_3_2_20_2 e_1_3_2_21_2 e_1_3_2_22_2 e_1_3_2_23_2 e_1_3_2_24_2 e_1_3_2_25_2 e_1_3_2_9_2 e_1_3_2_15_2 e_1_3_2_8_2 e_1_3_2_16_2 e_1_3_2_7_2 e_1_3_2_17_2 e_1_3_2_6_2 e_1_3_2_18_2 e_1_3_2_1_2 e_1_3_2_30_2 (e_1_3_2_19_2) 2005; 7 e_1_3_2_32_2 e_1_3_2_10_2 e_1_3_2_31_2 e_1_3_2_5_2 e_1_3_2_11_2 e_1_3_2_34_2 e_1_3_2_4_2 e_1_3_2_12_2 e_1_3_2_33_2 e_1_3_2_3_2 e_1_3_2_13_2 e_1_3_2_2_2 e_1_3_2_14_2 e_1_3_2_35_2 18378621 - Circulation. 2008 Apr 1;117(13):e300; author reply e301 |
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Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus... Patients after repair of tetralogy of Fallot (ToF) frequently have right ventricular (RV) dysfunction and prolonged QRS duration (QRSd) and thus could be... |
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| SubjectTerms | Adult Biological and medical sciences Blood and lymphatic vessels Bundle-Branch Block - diagnosis Bundle-Branch Block - physiopathology Bundle-Branch Block - therapy Cardiac Pacing, Artificial Cardiology. Vascular system Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Echocardiography - standards Electrocardiography General and cellular metabolism. Vitamins Heart Conduction System - physiopathology Heart Conduction System - surgery Humans Magnetic Resonance Imaging - standards Medical sciences Myocardial Contraction Pharmacology. Drug treatments Prospective Studies Reproducibility of Results Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Tetralogy of Fallot - diagnostic imaging Tetralogy of Fallot - physiopathology Tetralogy of Fallot - surgery Ventricular Function, Right - physiology |
| Subtitle | Implications of Infundibular Disease |
| Title | Right Ventricular Mechanics and QRS Duration in Patients With Repaired Tetralogy of Fallot |
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