Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study

Zhao, Xiaodan, Hu, Liwei, Leng, Shuang, Tan, Ru-San, Chai, Ping, Bryant, Jennifer Ann, Teo, Lynette L. S., Fortier, Marielle V., Yeo, Tee Joo, Ouyang, Rong Zhen, Allen, John C., Hughes, Marina, Garg, Pankaj, Zhang, Shuo, Van Der Geest, Rob J., Yip, James W., Tan, Teng Hong, Tan, Ju Le, Zhong, Yumin and Zhong, Liang (2022) Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study. Journal of Cardiovascular Magnetic Resonance, 24 (1). ISSN 1097-6647

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Abstract

Background: Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows quantification of biventricular blood flow by flow components and kinetic energy (KE) analyses. However, it remains unclear whether 4D flow parameters can predict cardiopulmonary exercise testing (CPET) as a clinical outcome in repaired tetralogy of Fallot (rTOF). Current study aimed to (1) compare 4D flow CMR parameters in rTOF with age- and gender-matched healthy controls, (2) investigate associations of 4D flow parameters with functional and volumetric right ventricular (RV) remodelling markers, and CPET outcome. Methods: Sixty-three rTOF patients (14 paediatric, 49 adult; 30 ± 15 years; 29 M) and 63 age- and gender-matched healthy controls (14 paediatric, 49 adult; 31 ± 15 years) were prospectively recruited at four centers. All underwent cine and 4D flow CMR, and all adults performed standardized CPET same day or within one week of CMR. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes. Four flow components were analyzed: direct flow, retained inflow, delayed ejection flow and residual volume. Additionally, three phasic KE parameters normalized to end-diastolic volume (KEi EDV), were analyzed for both LV and RV: peak systolic, average systolic and peak E-wave. Results: In comparisons of rTOF vs. healthy controls, median LV retained inflow (18% vs. 16%, P = 0.005) and median peak E-wave KEi EDV (34.9 µJ/ml vs. 29.2 µJ/ml, P = 0.006) were higher in rTOF; median RV direct flow was lower in rTOF (25% vs. 35%, P < 0.001); median RV delayed ejection flow (21% vs. 17%, P < 0.001) and residual volume (39% vs. 31%, P < 0.001) were both greater in rTOF. RV KEi EDV parameters were all higher in rTOF than healthy controls (all P < 0.001). On multivariate analysis, RV direct flow was an independent predictor of RV function and CPET outcome. RV direct flow and RV peak E-wave KEi EDV were independent predictors of RV remodelling index. Conclusions: In this multi-scanner multicenter 4D flow CMR study, reduced RV direct flow was independently associated with RV dysfunction, remodelling and, to a lesser extent, exercise intolerance in rTOF patients. This supports its utility as an imaging parameter for monitoring disease progression and therapeutic response in rTOF. Clinical Trial Registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT03217240.

Item Type: Article
Additional Information: Funding Information: This study received funding support from the National Medical Research Council of Singapore (Grant Nos. NMRC/OFIRG/0018/2016, MOH-000358, MOH-000351). The funder had no role in the design and conduct of the study; collection; management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Uncontrolled Keywords: 4d flow cmr,cardiopulmonary exercise testing,flow components,kinetic energy,repaired tetralogy of fallot,radiological and ultrasound technology,radiology nuclear medicine and imaging,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/3600/3614
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 13 Jan 2022 11:30
Last Modified: 16 Apr 2022 00:28
URI: https://ueaeprints.uea.ac.uk/id/eprint/83011
DOI: 10.1186/s12968-021-00832-2

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