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Cardiac Magnetic Resonance Feature Tracking Biventricular Two-Dimensional and Three-Dimensional Strains to Evaluate Ventricular Function in Children After Repaired Tetralogy of Fallot as Compared with Healthy Children

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Abstract

Cardiac magnetic resonance imaging is an important tool to evaluate cardiac anatomy and ventricular size and function after repaired tetralogy of Fallot. Magnetic resonance tissue tagging is the gold standard for evaluation of myocardial strain. However, myocardial tagging strain requires tagged images to be obtained prospectively, during the scan and with limited temporal resolution. Cardiac magnetic resonance feature tracking is a new tool that allows the retrospective analysis of cine images. There is limited experience with cardiac magnetic resonance feature tracking strain analysis in children. The medical records of patients with repaired tetralogy of Fallot that had a cardiac magnetic resonance (CMR) study from December 2013 to June 2015 were reviewed. The control group included patients who underwent a CMR with normal cardiac anatomy and ventricular function. Global longitudinal, circumferential and radial strain parameters (2D and 3D) were obtained by retrospectively contouring cine images from ventricular short axis, two chamber and four chamber views using post-processing software (Circle CVi42, Calgary, Canada). The correlation between conventional ventricular function parameters and ventricular strain was performed using Pearson’s correlation. The mean age of tetralogy of Fallot and control subjects was 12.4 and 14.1 years, respectively. In patients after repaired tetralogy of Fallot, the mean left ventricular global 2D and 3D circumferential strains were −17.4 ± 2.9 and −10.1 ± 3, respectively. The mean indexed right ventricular end-diastolic volume was 135.4 cc m2 ± 46 compared to 75.7 cc m2 ± 17 in control subjects (P = 0.0001, CI 95%). Left ventricular global circumferential 3D strain showed a statistically significant difference in patients after TOF repair compared to normal subjects (−10.1 ± 3 vs. −14.71 ± 1.9, P = 0.00001). A strong correlation between left ventricular global circumferential 3D strain and right ventricular end-diastolic volume (P ≤ 0.0001) was noted. We found a strong correlation between left ventricular circumferential 3D strain and indexed right ventricular end-diastolic volume, as well as a strong correlation between left ventricular longitudinal 2D strain and right ventricular ejection fraction. Circumferential 3D strain may be a suitable tool to detect early abnormalities of ventricular myocardium even before the ejection fraction becomes compromised. Large-scale prospective studies are recommended.

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Abbreviations

CMR:

Cardiac magnetic resonance

CMR-FT:

Cardiac magnetic resonance feature tracking

LV:

Left ventricle

RV:

Right ventricle

iLVESV:

Indexed left ventricular end-systolic volume

iLVEDV:

Indexed left ventricular end-diastolic volume

iRVESV:

Indexed right ventricular end-systolic volume

iRVEDV:

Indexed right ventricular end-diastolic volume

LVEF:

Left ventricle ejection fraction

RVEF:

Right ventricle ejection fraction

GRS:

Global radial strain

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

2D:

Two-dimensional

3D:

Three-dimensional

rTOF:

Repaired tetralogy of Fallot

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Acknowledgements

We are grateful to all staff involved in the care of our study subjects at Driscoll Children’s Hospital. We would also like to thank Jose H. Guardiola Ph.D., Department of Mathematics and Statistics, Texas A&M University for his collaboration on the statistical analysis.

Authors Contribution

FMB gathered study information, analyzed the data and wrote the manuscript. CGdA also contributed equally and made substantial contributions to writing of the manuscript, data analysis and bibliography background. DA contributed to the research idea, and also in charge of the clinical MRI reporting and post-processing of cine images for feature tracking. NO and DA were involved in the data analysis and edition of the final manuscript.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Driscoll Children’s Hospital, Corpus Christi, TX, USA

    Fernando M. Berganza, Cesar Gonzalez de Alba & Nazire Özcelik

  2. Division of Pediatric Cardiology, Memorial Hermann Children’s Hospital, University of Texas Medical School at Houston, Houston, TX, USA

    Dilachew Adebo

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  1. Fernando M. Berganza
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Correspondence to Dilachew Adebo.

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Berganza, F.M., de Alba, C.G., Özcelik, N. et al. Cardiac Magnetic Resonance Feature Tracking Biventricular Two-Dimensional and Three-Dimensional Strains to Evaluate Ventricular Function in Children After Repaired Tetralogy of Fallot as Compared with Healthy Children. Pediatr Cardiol 38, 566–574 (2017). https://doi.org/10.1007/s00246-016-1549-6

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  • DOI: https://doi.org/10.1007/s00246-016-1549-6

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