48th Annual Meeting of the German Society for Pediatric Cardiology (DGPK)

Objective: In patients with repaired tetralogy of Fallot, to assess the value of new parameters derived from nonconventional echocardiography in reflecting the right ventricular insufficiency status determined by N-terminal pro-B-type natriuretic peptide(NT-pro BNP). Design and patients: Forty patients with mean age of 29.5 +/- 12.23 years and mean follow up period of 25.85 +/- 10.27 years after surgical repair of tetralogy of Fallot were studied. Right ventricular end-diastolic volume indexed by body surface area (RVEDVI), right ventricular end-systolic volume indexed by body surface area (RVESVI), and right ventricular ejection fraction (RVEF) were derived from three dimensional echocardiographic (TDE) using a novel software provided from Tom-Tec. The software was validated by comparison with magnetic resonance imaging in 20 patients. Global right ventricular strain rate (GRVSR) and global right ventricular strain (GRVS) were derived from speckle tracking echocardiography (STE) in 4 chamber view. NT-pro BNP was determined in the local laboratory with commercially available kit. Results: The mean RVEDVI, RVESVI, and RVEF among the studied patients was 109.8 +/- 39.7 mL/m(2), 64.3 +/- 26.5 mL/m(2), and 41.8 +/- 9.3%, respectively. There was good agreement and correlation between three dimensional echocardiographic and magnetic resonance assessment of RVEDVI (r = 0.91, p = 0.001), RVESVI (r = 0.92, p = 0.001) and RV ejection fraction (r = 0.90, p = 0.001). The mean level of NT-pro BNP among the studied patients was 313.6 +/- 489.2 pg/mL. A correlation was found between the (NT-pro BNP and age of the patient (r = -0.54, p = 0.001), GRVSR (r = -0.74, p = 0.0001), GRVS (r = -0.42, p = 0.006), RVEDVI (r = 0.46, p = 0.003), RVESVI (r = 0.46, p = 0.003). No correlation was found between 3D RVEF and NT-pro BNP. For prediction of RV insufficiency (defined as NT-pro BNP level above116 pg/mL) the area under the ROC curve of GRVSR, GRVS, and RVEF was 0.96, 0.76, and 0.58, respectively. Conclusion: TDE using the novel software is useful for evaluation of RV volumes and ejection fraction. The load independent GRVSR rather than the load dependent GRVS and 3D RVEF is more promising in reflecting the RV insufficiency status determined by NT-pro BNP.