Serial RV wall stress measurements: association with right ventricular function in repaired Tetralogy of Fallot patients.

Autor: Minderhoud SCS; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Hirsch A; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Marin F; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy., Kardys I; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Rodríguez-Matas JF; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy., Chiastra C; PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy., Roos-Hesselink JW; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Wentzel JJ; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Helbing WA; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.; Division of Paediatric Cardiology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.; Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Nijmegen, Netherlands., Akyildiz AC; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.; Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands.
Jazyk: angličtina
Zdroj: Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2023 Oct 19; Vol. 10, pp. 1256792. Date of Electronic Publication: 2023 Oct 19 (Print Publication: 2023).
DOI: 10.3389/fcvm.2023.1256792
Abstrakt: Background: Optimal timing of pulmonary valve replacement (PVR) in Tetralogy of Fallot (TOF) patients remains challenging. Ventricular wall stress is considered to be an early marker of right ventricular (RV) dysfunction.
Objectives: To investigate the association of RV wall stresses and their change over time with functional parameters in TOF patients.
Methods: Ten TOF patients after surgical repair with moderate/severe pulmonary regurgitation were included. At two timepoints (median follow-up time 7.2 years), patient-specific computational biventricular models for wall stress assessment were created using CMR short-axis cine images and echocardiography-based RV pressures. RV ejection fraction (RVEF), NT-proBNP and cardiopulmonary exercise tests were used as outcome measures reflecting RV function. Associations between regional RV diastolic wall stress and RV function were investigated using linear mixed models.
Results: Increased wall stress correlated with lower RV mass ( r rm  = -0.70, p  = 0.017) and lower RV mass-to-volume ( r rm  = -0.80, p  = 0.003) using repeated measures. Wall stress decreased significantly over time, especially in patients with a stable RVEF ( p  < 0.001). Higher wall stress was independently associated with lower RVEF, adjusted for left ventricular ejection fraction, RV end-diastolic volume and time since initial surgery (decrease of 1.27% RVEF per kPa increase in wall stress, p  = 0.029) using repeated measurements. No association was found between wall stress, NT-proBNP, and exercise capacity.
Conclusions: Using a computational method to calculate wall stress locally in geometrically complex ventricles, we demonstrated that lower wall stress might be important to maintain ventricular function. RV wall stress assessment can be used in serial follow-up, and is potentially an early marker of impending RV dysfunction.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
(© 2023 Minderhoud, Hirsch, Marin, Kardys, Rodríguez-Matas, Chiastra, Roos-Hesselink, Wentzel, Helbing and Akyildiz.)
Databáze: MEDLINE
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