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Altered biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and right ventricular volume overload because of pulmonary regurgitation

Sjöberg, Pia LU ; Töger, Johannes LU ; Hedström, Erik LU ; Arvidsson, Per Martin LU ; Heiberg, Einar LU ; Arheden, Hakan LU ; Gustafsson, Ronny LU ; Nozohoor, Shahab LU and Carlsson, Marcus LU (2018) In American Journal of Physiology - Heart and Circulatory Physiology 315(6). p.1691-1702
Abstract

Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in repaired tetralogy of Fallot (rToF) patients to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and PR>20% (n=18) and healthy controls (n=15) underwent magnetic resonance imaging (MRI) including 4D-flow. A subset of patients (n=8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces... (More)

Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in repaired tetralogy of Fallot (rToF) patients to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and PR>20% (n=18) and healthy controls (n=15) underwent magnetic resonance imaging (MRI) including 4D-flow. A subset of patients (n=8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared to controls in the lateral-septal/LVOT (p=0.011; p=0.0031) and inferior-anterior (p<0.0001; p<0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared to controls in the diaphragm-RVOT (p<0.001) and apical-basal (p=0.0017) directions. After PVR RV systolic forces in the diaphragm-RVOT direction decreased (p=0.039) to lower levels than in controls (p=0.0064). RV diastolic forces decreased in all directions (p=0.0078; p=0.0078; p=0.039) but were still higher than in controls in diaphragm-RVOT direction (p=0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with the intraventricular blood flow compared to controls and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in LV and RV after PVR suggest that biventricular pumping does not normalize after surgery.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
American Journal of Physiology - Heart and Circulatory Physiology
volume
315
issue
6
pages
1691 - 1702
publisher
American Physiological Society
external identifiers
  • scopus:85060147442
ISSN
1522-1539
DOI
10.1152/ajpheart.00330.2018
language
English
LU publication?
yes
id
48a9caf7-a48e-471d-a1e6-cf9e8cf7c9aa
date added to LUP
2018-10-06 07:14:08
date last changed
2019-02-20 11:29:30
@article{48a9caf7-a48e-471d-a1e6-cf9e8cf7c9aa,
  abstract     = {<p>Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in repaired tetralogy of Fallot (rToF) patients to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and PR&gt;20% (n=18) and healthy controls (n=15) underwent magnetic resonance imaging (MRI) including 4D-flow. A subset of patients (n=8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared to controls in the lateral-septal/LVOT (p=0.011; p=0.0031) and inferior-anterior (p&lt;0.0001; p&lt;0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared to controls in the diaphragm-RVOT (p&lt;0.001) and apical-basal (p=0.0017) directions. After PVR RV systolic forces in the diaphragm-RVOT direction decreased (p=0.039) to lower levels than in controls (p=0.0064). RV diastolic forces decreased in all directions (p=0.0078; p=0.0078; p=0.039) but were still higher than in controls in diaphragm-RVOT direction (p=0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with the intraventricular blood flow compared to controls and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in LV and RV after PVR suggest that biventricular pumping does not normalize after surgery.</p>},
  author       = {Sjöberg, Pia and Töger, Johannes and Hedström, Erik and Arvidsson, Per Martin and Heiberg, Einar and Arheden, Hakan and Gustafsson, Ronny and Nozohoor, Shahab and Carlsson, Marcus},
  issn         = {1522-1539},
  language     = {eng},
  month        = {12},
  number       = {6},
  pages        = {1691--1702},
  publisher    = {American Physiological Society},
  series       = {American Journal of Physiology - Heart and Circulatory Physiology},
  title        = {Altered biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and right ventricular volume overload because of pulmonary regurgitation},
  url          = {http://dx.doi.org/10.1152/ajpheart.00330.2018},
  volume       = {315},
  year         = {2018},
}