Right Ventricular Mechanics in Adults After Surgical Repair of Tetralogy of Fallot: Insights From Three-Dimensional Speckle-Tracking Echocardiography

J Am Soc Echocardiogr. 2014 Apr;27(4):423-9. doi: 10.1016/j.echo.2013.12.021. Epub 2014 Feb 6.


Background: The clinical relevance of evaluating right ventricular (RV) myocardial deformation in congenital heart disease is increasingly recognized. The aim of this study was to explore, using three-dimensional (3D) speckle-tracking echocardiography, RV mechanics in terms of 3D global area strain and mechanical dyssynchrony in adults with repaired tetralogy of Fallot.

Methods: Twenty patients (12 men) aged 24.7 ± 8.6 years and 22 age-matched controls (11 men) were studied. Global RV peak area strain and area strain-derived systolic dyssynchrony index (SDI) were determined using 3D speckle-tracking echocardiography. RV end-diastolic volume and end-systolic volume, ejection fraction (EF), and pulmonary regurgitation fraction were measured in patients using cardiac magnetic resonance.

Results: Coefficients of variation for intraobserver and interobserver measurements of RV global area strain were 6.1% and 7.9%, respectively, and those for SDI were 7.6% and 10.1%, respectively. Compared with controls, patients had significantly lower global area strain (P = .005) and greater SDI (P = .008). The prevalence of RV mechanical dyssynchrony (SDI > control mean + 2 SDs) in patients was 30%. In patients, global area strain correlated inversely with SDI (r = -0.42, P = .04), RV end-diastolic volume (r = -0.48, P = .032), and RV end-systolic volume (r = -0.48, P = .031) and positively with EF (r = -0.51, P = .02), while RV SDI correlated positively with RV end-systolic volume (r = 0.55, P = .012), pulmonary regurgitation fraction (r = 0.54, P = .031), and QRS duration (r = 0.51, P = .022) and negatively with RV EF (r = -0.62, P = .004). Multivariate analysis showed that RV EF (β = 0.22, P = .048) was a significant correlate of global area strain in patients.

Conclusions: In adults after tetralogy of Fallot repair, 3D RV deformation is impaired in association with RV dyssynchrony, volume overloading, and reduced EF.

Keywords: 3D speckle-tracking; Mechanics; Right ventricle; Tetralogy of Fallot.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiac Surgical Procedures
  • Echocardiography, Three-Dimensional / methods*
  • Elastic Modulus
  • Elasticity Imaging Techniques / methods*
  • Female
  • Humans
  • Male
  • Reconstructive Surgical Procedures
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Stress, Mechanical
  • Stroke Volume
  • Tetralogy of Fallot / diagnostic imaging
  • Tetralogy of Fallot / physiopathology*
  • Tetralogy of Fallot / surgery*
  • Treatment Outcome
  • Ventricular Dysfunction, Right / diagnostic imaging
  • Ventricular Dysfunction, Right / physiopathology*
  • Ventricular Dysfunction, Right / surgery*
  • Young Adult