Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12968-021-00832-2
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dc.titleVentricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study
dc.contributor.authorZhao, Xiaodan
dc.contributor.authorHu, Liwei
dc.contributor.authorLeng, Shuang
dc.contributor.authorTan, Ru-San
dc.contributor.authorChai, Ping
dc.contributor.authorBryant, Jennifer Ann
dc.contributor.authorTeo, Lynette LS
dc.contributor.authorFortier, Marielle V
dc.contributor.authorYeo, Tee Joo
dc.contributor.authorOuyang, Rong Zhen
dc.contributor.authorAllen, John C
dc.contributor.authorHughes, Marina
dc.contributor.authorGarg, Pankaj
dc.contributor.authorZhang, Shuo
dc.contributor.authorvan der Geest, Rob J
dc.contributor.authorYip, James W
dc.contributor.authorTan, Teng Hong
dc.contributor.authorTan, Ju Le
dc.contributor.authorZhong, Yumin
dc.contributor.authorZhong, Liang
dc.date.accessioned2022-06-07T06:10:40Z
dc.date.available2022-06-07T06:10:40Z
dc.date.issued2022-01-03
dc.identifier.citationZhao, Xiaodan, Hu, Liwei, Leng, Shuang, Tan, Ru-San, Chai, Ping, Bryant, Jennifer Ann, Teo, Lynette LS, Fortier, Marielle V, Yeo, Tee Joo, Ouyang, Rong Zhen, Allen, John C, Hughes, Marina, Garg, Pankaj, Zhang, Shuo, van der Geest, Rob J, Yip, James W, Tan, Teng Hong, Tan, Ju Le, Zhong, Yumin, Zhong, Liang (2022-01-03). Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study. JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE 24 (1). ScholarBank@NUS Repository. https://doi.org/10.1186/s12968-021-00832-2
dc.identifier.issn10976647
dc.identifier.issn1532429X
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/226617
dc.description.abstractBackground: Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows quantification of biventricular blood flow by flow components and kinetic energy (KE) analyses. However, it remains unclear whether 4D flow parameters can predict cardiopulmonary exercise testing (CPET) as a clinical outcome in repaired tetralogy of Fallot (rTOF). Current study aimed to (1) compare 4D flow CMR parameters in rTOF with age- and gender-matched healthy controls, (2) investigate associations of 4D flow parameters with functional and volumetric right ventricular (RV) remodelling markers, and CPET outcome. Methods: Sixty-three rTOF patients (14 paediatric, 49 adult; 30 ± 15 years; 29 M) and 63 age- and gender-matched healthy controls (14 paediatric, 49 adult; 31 ± 15 years) were prospectively recruited at four centers. All underwent cine and 4D flow CMR, and all adults performed standardized CPET same day or within one week of CMR. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes. Four flow components were analyzed: direct flow, retained inflow, delayed ejection flow and residual volume. Additionally, three phasic KE parameters normalized to end-diastolic volume (KEiEDV), were analyzed for both LV and RV: peak systolic, average systolic and peak E-wave. Results: In comparisons of rTOF vs. healthy controls, median LV retained inflow (18% vs. 16%, P = 0.005) and median peak E-wave KEiEDV (34.9 µJ/ml vs. 29.2 µJ/ml, P = 0.006) were higher in rTOF; median RV direct flow was lower in rTOF (25% vs. 35%, P < 0.001); median RV delayed ejection flow (21% vs. 17%, P < 0.001) and residual volume (39% vs. 31%, P < 0.001) were both greater in rTOF. RV KEiEDV parameters were all higher in rTOF than healthy controls (all P < 0.001). On multivariate analysis, RV direct flow was an independent predictor of RV function and CPET outcome. RV direct flow and RV peak E-wave KEiEDV were independent predictors of RV remodelling index. Conclusions: In this multi-scanner multicenter 4D flow CMR study, reduced RV direct flow was independently associated with RV dysfunction, remodelling and, to a lesser extent, exercise intolerance in rTOF patients. This supports its utility as an imaging parameter for monitoring disease progression and therapeutic response in rTOF. Clinical Trial Registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT03217240.
dc.language.isoen
dc.publisherBMC
dc.sourceElements
dc.subjectScience & Technology
dc.subjectLife Sciences & Biomedicine
dc.subjectCardiac & Cardiovascular Systems
dc.subjectRadiology, Nuclear Medicine & Medical Imaging
dc.subjectCardiovascular System & Cardiology
dc.subjectRepaired tetralogy of Fallot
dc.subjectKinetic energy
dc.subject4D flow CMR
dc.subjectFlow components
dc.subjectCardiopulmonary exercise testing
dc.subjectKINETIC-ENERGY
dc.subjectMRI
dc.subjectDYSFUNCTION
dc.subjectARRHYTHMIA
dc.subjectDYNAMICS
dc.subjectVOLUME
dc.subjectDEATH
dc.typeArticle
dc.date.updated2022-06-07T06:08:18Z
dc.contributor.departmentMECHANOBIOLOGY INSTITUTE
dc.contributor.departmentDUKE-NUS MEDICAL SCHOOL
dc.contributor.departmentDEPT OF MEDICINE
dc.contributor.departmentDEPT OF DIAGNOSTIC RADIOLOGY
dc.description.doi10.1186/s12968-021-00832-2
dc.description.sourcetitleJOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE
dc.description.volume24
dc.description.issue1
dc.published.statePublished
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