Cardiac Function After Repair of Tetralogy of Fallot: How are the Atria Performing? Pilot Study by Cardiac Magnetic Resonance Imaging
Tóm tắt
The atria of the heart function as reservoir, conduit, and active pump and are critical for ventricular filling and cardiac output. We sought to evaluate right (RA) and left atrial (LA) function in patients after tetralogy of Fallot (TOF) repair by using cardiovascular magnetic resonance. Twelve TOF patients, age 16.7 ± 6.1 years, weight 50.9 ± 14.9 kg, were compared to 10 healthy volunteers, age 18.8 ± 6.8 years, weight 52.3 ± 20.8 kg. Both atria and both ventricles were imaged in short-axis planes by Steady State Free Precession. Volume changes and all derived atrial functional parameters were calculated from the volume/time curves obtained after segmentation on the cine images. Blood flow across the AV valves was used to define ventricular diastolic dysfunction. TOF patients showed similar maximal RA volume compared to controls, but increased volumes at mid-diastole (p < 0.05), resulting in a decreased cyclic volume change and atrial filling fraction (p < 0.01), and a decreased passive emptying volume and fraction (p < 0.01). In patients with diastolic dysfunction, conduit volume was increased (p < 0.05), and active emptying volume and fraction tended to be increased, respectively. No significant changes were found in LA, except for a decreased passive emptying fraction (p < 0.05). RA function and particularly reservoir function are impaired in TOF patients. The RA conduit/reservoir ratio is increased and reflects the lost of the ability of the atrium to fill the ventricle by pulsatile flow.
Tài liệu tham khảo
Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, Tsang TS (2006) Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 47:2357–2363. doi:10.1016/j.jacc.2006.02.048
Arcilla RA, Thilenius OG, Chiemmongkoltip P, Ranniger K (1973) Left atrial volume calculation by angiocardiography in children. Chest 63:189–197
Benjamin EJ, D’Agostino RB, Belanger AJ, Wolf PA, Levy D (1995) Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 92:835–841
Buechel EV, Kaiser T, Jackson C, Schmitz A, Kellenberger CJ (2009) Normal right- and left ventricular volumes and myocardial mass in children measured by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 11(1):19. doi:10.1186/1532-429X-11-19
Dragulescu A, Grosse-Wortmann L, Redington A, Friedberg MK, Mertens L (2013) Differential effect of right ventricular dilatation on myocardial deformation in patients with atrial septal defects and patients after tetralogy of Fallot repair. Int J Cardiol 168(2):803–810. doi:10.1016/j.ijcard.2012.10.009
Gaynor SL, Maniar HS, Prasad SM, Steendijk P, Moon MR (2005) Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output. Am J Physiol Heart Circ Physiol 288(5):H2140–H2145. doi:10.1152/ajpheart.00566.2004
Hawley RR, Dodge HT, Graham TP (1966) Left atrial volume and its changes in heart disease. Circulation 34:989–996
Hui W, Abd El Rahman MY, Dsebissowa F, Rentzsch A, Gutberlet M, Alexi-Meskishvili V, Hetzer R, Lange PE, Abdul-Khaliq H (2004) Quantitative analysis of right atrial performance after surgical repair of tetralogy of Fallot. Cardiol Young 14(5):520–526. doi:10.1017/S1047951104005098
Järvinen V, Kupari M, Hekali P, Poutanen VP (1994) Assessment of left atrial volumes and phasic function using cine magnetic resonance imaging in normal subjects. Am J Cardiol 73(15):1135–1138
Järvinen VM, Kupari MM, Poutanen VP, Hekali PE (1996) Right and left atrial phasic volumetric function in mildly symptomatic dilated and hypertrophic cardiomyopathy: cine MR imaging assessment. Radiology 198:487–495. doi:10.1148/radiology.198.2.8596854
Lester SJ, Ryan EW, Schiller NB, Foster E (1999) Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol 84(7):829–832
Leung DY, Boyd A, Ng AA, Chi C, Thomas L (2008) Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J 156(6):1056–1064. doi:10.1016/j.ahj.2008.07.021
Luijnenburg SE, Perters RE, van der Geest RJ, Moelker A, Roos-Hesselink JW, de Rijke YB, Mulder BJM, Vielegn HW, Helbing WA (2013) Abnormal right atrial and right ventricular diastolic function related to impaired clinical condition in patients operated for tetralogy of Fallot. Int J Cardiol 167:833–839
Poutanen T, Ikonen A, Vainio P, Jokinen E, Tikanoja T (2000) Left atrial volume assessed by transthoracic three dimensional echocardiography and magnetic resonance imaging: dynamic changes during the heart cycle in children. Heart 83(5):537–542
Poutanen T, Jokinen E, Sairanen H, Tikanoja T (2003) Left atrial and left ventricular function in healthy children and young adults assessed by three dimensional echocardiography. Heart 89:544–549
Prioli A, Marino P, Lanzoni L, Zardini P (1998) Increasing degrees of left ventricular filling impairment modulate left atrial function in humans. Am J Cardiol 82(6):756–761
Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM (2003) Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol 41(6):1036–1043
Riesenkampff E, Mengelkamp L, Mueller M, Kropf S, Abdul-Khaliq H, Sarikouch S, Beerbaum P, Hetzer R, Steendijk P, Berger F, Kuehne T (2010) Integrated analysis of atrioventricular interactions in tetralogy of Fallot. Am J Physiol Heart Circ Physiol 299(2):H364–H371. doi:10.1152/ajpheart.00264.2010
Riesenkampff E, Al-Wakeel N, Kropf S, Stamm C, Alexi-Meskishvili V, Berger F, Kuehne T (2014) Surgery impacts right atrial function in tetralogy of Fallot. J Thorac Cardiovasc Surg 147(4):1306–1311
Rossi A, Zardini P, Marino P (2000) Modulation of left atrial function by ventricular filling impairment. Heart Fail Rev 5(4):325–331
Sarikouch S, Koerperich H, Boethig D, Peters B, Lotz J, Gutberlet M, Beerbaum P, Kuehne T (2011) Reference values for atrial size and function in children and young adults by cardiac MR: a study of the German competence network congenital heart defects. J Magn Reson Imaging 33(5):1028–1039. doi:10.1002/jmri.22521
Sievers B, Addo M, Breuckmann F, Barkhausen J, Erbel R (2007) Reference right atrial function determined by steady-state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 9(5):807–814. doi:10.1080/10976640701545552
Stefanadis C, Dernellis J, Toutouzas P (2001) A clinical appraisal of left atrial function. Eur Heart J 22(1):22–36. doi:10.1053/euhj.1999.2581
Suga H (1974) Importance of atrial compliance in cardiac performance. Circ Res 35(1):39–43
To ACY, Flamm SD, Marwick TH, Klein AL (2011) Clinical utility of multimodality LA imaging: assessment of size, function, and structure. JACC Cardiovasc Imaging 4(7):788–798. doi:10.1016/j.jcmg.2011.02.018
Toutouzas K, Trikas A, Pitsavos C, Barbetseas J, Androulakis A, Stefanadis C, Toutouzas P (1996) Echocardiographic features of left atrium in elite male athletes. Am J Cardiol 78:1314–1317
Vizzardi E, D’Aloia A, Rocco E, Lupi L, Rovetta R, Quinzani F, Bontempi L, Curnis Md A, Dei Cas L (2012) How should we measure left atrium size and function? J Clin Ultrasound 40(3):155–166. doi:10.1002/jcu.21871