Multivariable assessment of the right ventricle by echocardiography in patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement: a comparative study with magnetic resonance imaging

Arch Cardiovasc Dis. 2015 Jan;108(1):5-15. doi: 10.1016/j.acvd.2014.07.054. Epub 2014 Nov 12.

Abstract

Background: Evaluation of the right ventricle (RV) using transthoracic echocardiography is challenging in patients with repaired tetralogy of Fallot (rTOF).

Aims: To evaluate the accuracy of conventional echocardiographic variables and real-time three-dimensional echocardiography (RT3DE) in assessing right ventricular (RV) volumes and function compared with magnetic resonance imaging (MRI), in adult patients with rTOF and referred for pulmonary valve replacement (PVR).

Methods: Complete echocardiography was performed on 26 consecutive patients referred for PVR, before and 1 year after surgery. All variables were compared with MRI.

Results: Correlations between conventional variables and MRI were absent or poor when assessing RV ejection fraction (RVEF), except for fractional area of change (FAC; r=0.70, P<0.01 before PVR; r=0.68, P<0.01 after PVR) and RT3DE (r=0.96, P<0.01 before PVR; r=0.98, P<0.01 after PVR). The RV volume correlation between RT3DE and MRI was excellent before and after surgery for RV end-diastolic volume (r=0.88, P<0.01 and r=0.91, P<0.01, respectively) and RV end-systolic volume (r=0.92, P<0.01 and r=0.95, P<0.01, respectively). The accuracy of these indices, as a diagnostic test for impaired RV (<45%), was good: Youden's indexes varied from 0.47 to 0.89; areas under the receiver operating characteristic curve before and after PVR were 0.86 and 0.81 for FAC and 0.98 and 0.97 for RT3DE, respectively.

Conclusion: Commonly used echocardiography variables, such as tricuspid annular plane systolic excursion and tricuspid annular peak systolic velocity, did not sensitively evaluate global RVEF. A global approach, that includes the whole RV and integration of its different components, was more reliable in patients with rTOF.

Keywords: Echocardiography; IRM; Magnetic resonance imaging; Pulmonary valve replacement; Remplacement valvulaire pulmonaire; Right ventricle; Tetralogy of Fallot; Tétralogie de Fallot; Ventricule droit; Échocardiographie.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Area Under Curve
  • Cardiac Surgical Procedures / adverse effects*
  • Echocardiography, Three-Dimensional*
  • Feasibility Studies
  • Female
  • Heart Valve Prosthesis Implantation*
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Multivariate Analysis
  • Predictive Value of Tests
  • Pulmonary Valve / diagnostic imaging
  • Pulmonary Valve / physiopathology
  • Pulmonary Valve / surgery*
  • Pulmonary Valve Insufficiency / diagnostic imaging
  • Pulmonary Valve Insufficiency / etiology
  • Pulmonary Valve Insufficiency / physiopathology
  • Pulmonary Valve Insufficiency / surgery*
  • ROC Curve
  • Stroke Volume
  • Tetralogy of Fallot / surgery*
  • Time Factors
  • Treatment Outcome
  • Tricuspid Valve / diagnostic imaging
  • Tricuspid Valve / physiopathology
  • Ventricular Dysfunction, Right / diagnostic imaging*
  • Ventricular Dysfunction, Right / etiology
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Function, Right*
  • Young Adult