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Novel Two-Dimensional Global Longitudinal Strain and Strain Rate Imaging for Assessment of Systemic Right Ventricular Function
  1. Pak-Cheong Chow
  1. The University of Hong Kong, Hong Kong
    1. Xue-Cun Liang
    1. The University of Hong Kong, Hong Kong
      1. Eddie WY Cheung
      1. The University of Hong Kong, Hong Kong
        1. Wendy WM Lam
        1. The University of Hong Kong, Hong Kong
          1. Y F Cheung (xfcheung{at}
          1. University of Hong Kong, Hong Kong


            Objectives To determine the usefulness of novel two-dimensional strain indices, based on speckle tracking imaging, for assessment of systemic right ventricular (RV) function after atrial switch operation for transposition of the great arteries.

            Design Cross-sectional study.

            Setting Tertiary paediatric cardiac centre.

            Methods Twenty-six patients, aged 21.0 iÓ 3.6 years at 19.9 iÓ 3.2 years after atrial switch operation, and 27 age-matched controls were studied. Two-dimensional imaging at the four-chamber view was obtained with tracing of the entire RV endocardial border. The RV global longitudinal strain (GLS) and GLS rate were derived using automated software (EchoPAC, GE Medical) and correlated with tissue Doppler-derived RV isovolumic acceleration (IVA), and, in patient cohort, with cardiac magnetic resonance-derived RV ejection fraction.

            Results Intraobserver and interobserver variability for measurement of GLS, as determined from mean iÓ SD of differences in 2 consecutive results from 20 studies, were 0.06 iÓ 1.93 % and 0.24 iÓ 1.77 % respectively. Compared with controls, patients had lower RV GLS (17.1 iÓ 1.9 % vs 26.3 iÓ 2.9 %, p<0.001), reduced GLS rate (0.78 iÓ 0.11 /s vs 1.33 iÓ 0.23 /s, p <0.001), lower RV IVA (1.10 iÓ 0.36 m/s2 vs 1.56 iÓ 0.53 m/s2, p=0.001), and increased RV myocardial performance index (0.52 iÓ 0.09 vs 0.38 iÓ 0.09, p=0.001). Both RV GLS and GLS rate correlated positively with RV IVA (r=0.43, p=0.001 and r=0.46, p<0.001, respectively), and negatively with RV myocardial performance index (r=-0.65, p<0.001 and r=-0.57, p<0.001 respectively). In patients, GLS rate correlated positively with RV ejection fraction (r=0.62, p=0.001).

            Conclusions Two-dimensional RV GLS and GLS rate are novel indices potentially useful for assessment of systemic RV function.

            • systemic right ventricular function
            • two-dimensional strain

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