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RIGHT AND LEFT VENTRICULAR MECHANICS ARE ALTERED IN ADOLESCENTS AND ADULTS LATE AFTER REPAIR OF SUBARTERIAL VENTRICULAR SEPTAL DEFECTS
610 JACC March 21, 2017 Volume 69, Issue 11
Congenital Heart Disease RIGHT AND LEFT VENTRICULAR MECHANICS ARE ALTERED IN ADOLESCENTS AND ADULTS LATE AFTER REPAIR OF SUBARTERIAL VENTRICULAR SEPTAL DEFECTS Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Adult Patients With Congenital Heart Disease: How Do They Compare? Abstract Category: 9. Congenital Heart Disease: Adult Presentation Number: 1142-016 Authors: Sit-Yee Kwok, Susanna Yeung, Wing Yi Li, Yiu-Fai Cheung, University of Hong Kong, Hong Kong, Hong Kong
Background: There is increasing concern of ventricular dysfunction in patients late after repair of perimembranous ventricular septal defect (VSD). We tested the hypothesis that right (RV) and left ventricular (LV) mechanics are altered in patients late after surgical closure of subarterial VSD and determined the associated risk factors. Methods: Twenty-nine patients aged 23.5±7.0 years, at 11.7±7.7 years after surgery, and 29 age-matched controls were studied. Global RV and LV function was assessed using M-mode, tissue Doppler, and speckle tracking echocardiography, while contractile function of RV outflow was assessed by determining its shortening fraction (SF).
Results: Residual aortic regurgitation was trivial/mild in 20 (68.9%) patients and moderate in 1 (3.4%). QRS duration (101±17 ms vs 91±9 ms, p=0.01) was significantly longer in patients than controls. Compared with controls, patients had significantly lower tricuspid annular systolic (p=0.003) and diastolic (p<0.001) velocities, isovolumic acceleration (p<0.001), and RV global longitudinal systolic strain (p=0.011), systolic strain rate (p=0.007), and late diastolic strain rate (p=0.04), and greater ratio of transtricuspid to tricuspid annular early diastolic velocities (p<0.001). Furthermore, their RV outflow SF (42.7±10.0 % vs 49.7±7.5 %, p=0.004) was reduced. For LV function, patients had significantly lower shortening fraction (p<0.001), global longitudinal systolic strain (p=0.006), systolic strain rate (p=0.003), and early (p=0.047) and late (p=0.04) diastolic strain rates than controls. The RV and LV systolic strain and systolic and diastolic strain rates were significantly associated (all p<0.05). For the entire cohort, QRS duration (r=-0.34, p=0.011), and RV outflow SF (r=0.40, p=0.002) were found to correlate significantly with LV systolic strain and tended to correlate with RV systolic strain (r=-0.23, p=0.097 and r=0.25, p=0.07, respectively). Conclusions: Right and left ventricular systolic and diastolic mechanics are significantly impaired and interrelated in patients after subarterial VSD repair, which in part may be related to prolonged QRS duration and RV outflow dysfunction.
Congenital Heart Disease RIGHT AND LEFT VENTRICULAR MECHANICS ARE ALTERED IN ADOLESCENTS AND ADULTS LATE AFTER REPAIR OF SUBARTERIAL VENTRICULAR SEPTAL DEFECTS Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Adult Patients With Congenital Heart Disease: How Do They Compare? Abstract Category: 9. Congenital Heart Disease: Adult Presentation Number: 1142-016 Authors: Sit-Yee Kwok, Susanna Yeung, Wing Yi Li, Yiu-Fai Cheung, University of Hong Kong, Hong Kong, Hong Kong
Background: There is increasing concern of ventricular dysfunction in patients late after repair of perimembranous ventricular septal defect (VSD). We tested the hypothesis that right (RV) and left ventricular (LV) mechanics are altered in patients late after surgical closure of subarterial VSD and determined the associated risk factors. Methods: Twenty-nine patients aged 23.5±7.0 years, at 11.7±7.7 years after surgery, and 29 age-matched controls were studied. Global RV and LV function was assessed using M-mode, tissue Doppler, and speckle tracking echocardiography, while contractile function of RV outflow was assessed by determining its shortening fraction (SF).
Results: Residual aortic regurgitation was trivial/mild in 20 (68.9%) patients and moderate in 1 (3.4%). QRS duration (101±17 ms vs 91±9 ms, p=0.01) was significantly longer in patients than controls. Compared with controls, patients had significantly lower tricuspid annular systolic (p=0.003) and diastolic (p<0.001) velocities, isovolumic acceleration (p<0.001), and RV global longitudinal systolic strain (p=0.011), systolic strain rate (p=0.007), and late diastolic strain rate (p=0.04), and greater ratio of transtricuspid to tricuspid annular early diastolic velocities (p<0.001). Furthermore, their RV outflow SF (42.7±10.0 % vs 49.7±7.5 %, p=0.004) was reduced. For LV function, patients had significantly lower shortening fraction (p<0.001), global longitudinal systolic strain (p=0.006), systolic strain rate (p=0.003), and early (p=0.047) and late (p=0.04) diastolic strain rates than controls. The RV and LV systolic strain and systolic and diastolic strain rates were significantly associated (all p<0.05). For the entire cohort, QRS duration (r=-0.34, p=0.011), and RV outflow SF (r=0.40, p=0.002) were found to correlate significantly with LV systolic strain and tended to correlate with RV systolic strain (r=-0.23, p=0.097 and r=0.25, p=0.07, respectively). Conclusions: Right and left ventricular systolic and diastolic mechanics are significantly impaired and interrelated in patients after subarterial VSD repair, which in part may be related to prolonged QRS duration and RV outflow dysfunction.