Energy Transfer Ratio as a Metric of Right Ventricular Efficiency in Repaired Congenital Heart Disease
| Autor: | Kan Hor, Namheon Lee, Ashish Das, Rupak K. Banerjee, Michael D. Taylor |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Body surface area
medicine.medical_specialty medicine.diagnostic_test Heart disease business.industry Pulmonary insufficiency General Medicine medicine.disease medicine.anatomical_structure Great arteries Cardiac magnetic resonance imaging Ventricle medicine.artery Internal medicine Pediatrics Perinatology and Child Health Pulmonary artery Cardiology Medicine Radiology Nuclear Medicine and imaging Surgery Cardiology and Cardiovascular Medicine business Tetralogy of Fallot |
| Zdroj: | Congenital Heart Disease. 8:328-342 |
| ISSN: | 1747-079X |
| DOI: | 10.1111/chd.12034 |
| Popis: | Objective. With the success of early repair, continued functional assessment of repaired congenital heart disease is critical for improved long-term outcome. Pulmonary regurgitation, which is one of the main postoperative sequelae of congenital heart disease involved with the right ventricle (RV) such as tetralogy of Fallot and transposition of the great arteries, results in progressive RV dilatation coupled with pulmonary artery (PA) obstruction causing elevated RV pressures. The appropriate timing of intervention to correct these postoperative lesions remains largely subjec- tive. In the present study, we evaluated an energy-based end point, namely energy transfer ratio (eMPA), to assess the degree of RV and PA inefficiency in a group of congenital heart disease patients with abnormal RV-PA physiology. Methods. Eight patients with abnormal RV-PA physiology and six controls with normal RV-PA physiology were investigated using a previously validated technique that couples cardiac magnetic resonance imaging and invasive pressure measurements. Results. The mean eMPA of the patient group (0.56 0.33) was significantly lower (P < .04) than that of the control group (1.56 0.85), despite the fact that the patient group had a significantly higher RV stroke work indexed to body surface area (RV SWI) than the control group (0.205 0.095 J/m 2 vs. 0.090 0.038 J/m 2 ; P < .02). Conclusion. We determined that the patients had inefficient RV-PA physiology due to a combination of RV dilatation with pulmonary regurgitation and RV outflow obstruction leading to an elevated end-systolic pressure. Using coupled magnetic resonance imaging and invasive pressure measurements, eMPA is determined to be a sensitive energy-based end point for measuring RV-PA efficiency. It may serve as a diagnostic end point to optimize timing of intervention. |
| Databáze: | OpenAIRE |
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