In repaired tetralogy of Fallot (rTOF), abnormal left ventricular (LV) rotational mechanics are associated with adverse clinical outcomes. We performed a comprehensive analysis of LV rotational mechanics in rTOF patients using cardiac magnetic resonance (CMR) prior to and following surgical pulmonary valve replacement (PVR). In this single center retrospective study, we identified rTOF patients who (1) had both a CMR ≤ 1 year before PVR and ≤ 5 years after PVR, (2) had no other intervening procedure between CMRs, (3) had a body surface area > 1.0 m2 at CMR, and (4) had images suitable for feature tracking analysis. These subjects were matched to healthy age- and sex-matched control subjects. CMR feature tracking analysis was performed on a ventricular short-axis stack of balanced steady-state free precession images. Measurements included LV basal and apical rotation, twist, torsion, peak systolic rates of rotation and torsion, and timing of events. Associations with LV torsion were assessed. A total of 60 rTOF patients (23.6 ± 7.9 years, 52% male) and 30 healthy control subjects (20.8 ± 3.1 years, 50% male) were included. Compared with healthy controls, rTOF patients had lower apical and basal rotation, twist, torsion, and systolic rotation rates, and these parameters peaked earlier in systole. The only parameters that were correlated with LV torsion were right ventricular (RV) end-systolic volume (r = − 0.28, p = 0.029) and RV ejection fraction (r = 0.26, p = 0.044). At a median of 1.0 year (IQR 0.5–1.7) following PVR, there was no significant change in LV rotational parameters versus pre-PVR despite reductions in RV volumes, RV mass, pulmonary regurgitation, and RV outflow tract obstruction. In this comprehensive study of CMR-derived LV rotational mechanics in rTOF patients, rotation, twist, and torsion were diminished compared to controls and did not improve at a median of 1 year after PVR despite favorable RV remodeling.

中文翻译：

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法洛四联症修复肺动脉瓣置换术对左心室旋转力学的影响


在修复法洛四联症 (rTOF) 中，左心室 (LV) 旋转力学异常与不良临床结果相关。我们在肺动脉瓣置换术 (PVR) 之前和之后使用心脏磁共振 (CMR) 对 rTOF 患者的左室旋转力学进行了全面分析。在这项单中心回顾性研究中，我们确定了 rTOF 患者：(1) PVR 前的 CMR ≤ 1 年且 PVR 后 ≤ 5 年，(2) CMR 之间没有其他干预程序，(3) 体表面积> 1.0 m2 (CMR)，并且 (4) 具有适合特征跟踪分析的图像。这些受试者与年龄和性别匹配的健康对照受试者相匹配。对平衡稳态自由进动图像的心室短轴堆栈进行 CMR 特征跟踪分析。测量包括左心室基底和心尖旋转、扭转、扭转、旋转和扭转的收缩期峰值速率以及事件发生时间。评估了与左室扭转的关联。总共包括 60 名 rTOF 患者（23.6 ± 7.9 岁，52% 男性）和 30 名健康对照受试者（20.8 ± 3.1 岁，50% 男性）。与健康对照相比，rTOF 患者的心尖和基底旋转、扭转、扭转和收缩期旋转率较低，并且这些参数在收缩期较早达到峰值。与 LV 扭转相关的唯一参数是右心室 (RV) 收缩末期容积 (r = − 0.28，p = 0.029) 和 RV 射血分数 (r = 0.26，p = 0.044)。在 PVR 后中位 1.0 年（IQR 0.5-1.7）时，尽管 RV 体积、RV 质量、肺动脉瓣反流和 RV 流出道阻塞有所减少，但与 PVR 前相比，LV 旋转参数没有显着变化。 在这项针对 rTOF 患者 CMR 衍生的 LV 旋转力学的综合研究中，与对照组相比，旋转、扭曲和扭转有所减少，并且尽管 RV 重塑良好，但在 PVR 后中位 1 年时并未改善。