Systemic right ventricular longitudinal strain is reduced in adults with transposition of the great arteries, relates to subpulmonary ventricular function, and predicts adverse clinical outcome

• Published in: The American heart journal 2012-05, Vol.163 (5), p.859-866
• Main Authors: Diller, Gerhard-Paul, MD, PhD, FESC, Radojevic, Jelena, MD, Kempny, Aleksander, MD, Alonso-Gonzalez, Rafael, MD, Emmanouil, Liodakis, MD, Orwat, Stefan, MD, Swan, Lorna, MB, ChB, FRCP, MD, Uebing, Anselm, MD, PhD, Li, Wei, MD, PhD, Dimopoulos, Konstantinos, MD, MSc, PhD, FESC, Gatzoulis, Michael A., MD, PhD, FESC, Baumgartner, Helmut, MD, FESC
• Format: Article
• Language: English
• Subjects: Adult; Age; Age Factors; Analysis of Variance; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Case-Control Studies; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Echocardiography, Doppler - methods; Female; Heart; Heart failure; Humans; Linear Models; Male; Medical sciences; Middle Aged; Mortality; Multivariate Analysis; Myocardial Contraction - physiology; NMR; Nuclear magnetic resonance; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Pulmonary Artery; Retrospective Studies; Risk Assessment; ROC Curve; Severity of Illness Index; Sex Factors; Software; Stress, Physiological; Stroke Volume - physiology; Studies; Survival Rate; Systole; Transposition of Great Vessels - diagnostic imaging; Transposition of Great Vessels - mortality; Transposition of Great Vessels - physiopathology; Transposition of Great Vessels - surgery; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - mortality; Ventricular Dysfunction, Right - physiopathology; Ventricular Function - physiology; Young Adult
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2012.01.038

Background Transposition of the great arteries (TGA) after atrial switch operation and congenitally corrected TGA (ccTGA) are commonly associated with impaired systemic right ventricular (RV) function and impaired prognosis. We aimed to investigate the value of indices of myocardial deformation on speckle-tracking echocardiography for quantifying ventricular function and their potential role in assessing ventricular-ventricular interaction and outcome in patients with a systemic RV. Methods and Results A total of 129 patients (87 with TGA and atrial switch and 42 with ccTGA, 71 men, age 35 ± 12 years) were investigated, and biventricular myocardial deformation was compared with findings in healthy subjects (n = 38, age 36 ± 10 years). Systemic ventricular longitudinal 2-dimensional (2D) peak systolic strain (RV 2D-LS) was significantly reduced compared with controls (−12.9 ± 3.6 and −15.4 ± 5.1 vs −21.0 ± 5.5 in TGAs, ccTGAs, and controls, P < .0001). Systemic and pulmonary 2D-LS were correlated in patients with TGA ( r = 0.46, P < .0001) and ccTGA ( r = 0.64, P < .0001), suggesting interventricular interaction, and this was confirmed when ejection fraction on magnetic resonance imaging was assessed ( r = 0.53, P < .0001). More importantly, systemic 2D-LS (hazard ratio 1.31, P = .01) was related to adverse clinical outcome (symptomatic progression to New York Heart Association class ≥3, clinically relevant cardiac arrhythmia, or death) in patients with TGA and atrial switch independently of ejection fraction on cardiac magnetic resonance imaging, history of clinically relevant arrhythmia, or functional class. Conclusions Global longitudinal systolic strain is significantly reduced in patients with a systemic RV, is related to subpulmonary ventricular function, and predicts adverse clinical outcome in adults with atrial switch TGA.