Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot
Aims Reliable evaluation of the severity and consequences of pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (TOF) is crucial to timely identify the need for pulmonary valve intervention. We aimed to identify the accuracy of echocardiographic parameters to differentiate be...
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| Veröffentlicht in: | Congenital heart disease 2019-07, Vol.14 (4), p.628-637 |
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| creator | Van Berendoncks, An Van Grootel, Roderick McGhie, Jackie van Kranenburg, Matthijs Menting, Myrthe Cuypers, Judith A.A.E. Bogers, Ad J.J.C. Witsenburg, Maarten Roos‐Hesselink, Jolien W. van den Bosch, Annemien E. |
| description | Aims
Reliable evaluation of the severity and consequences of pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (TOF) is crucial to timely identify the need for pulmonary valve intervention. We aimed to identify the accuracy of echocardiographic parameters to differentiate between moderate and severe PR, using phase contrast cardiac magnetic resonance imaging (CMR) as gold standard.
Methods and results
In this cross‐sectional study, 45 TOF patients with both echocardiographic and CMR measurements of PR were enrolled. All quantitative and semiquantitative echocardiographic measurements such as pressure half time (PHT), Color flow jet width (CFJW), ratio CFJW/right ventricle outflow tract (RVOT) diameter, PR index and the presence of early termination of the PR jet, end‐diastolic antegrade flow and diastolic backflow in main pulmonary artery (MPA), and PA branches correlated significantly with PR fraction on CMR. Qualitative assessment with color flow on echocardiography overestimated PR Multivariate linear regression analysis identified the ratio of CFJW/RVOT diameter and PHT as independent predictors of PR fraction. Accuracy of echo parameters was tested to differentiate between mild‐to‐moderate and severe PR Combining different echocardiographic parameters increased sensitivity and specificity. The addition of diastolic flow reversal in the PA branches to PHT below 167 milliseconds increased the NPV from 87% to 89% and PPV from 62% to 76%.
Conclusions
Comparison with CMR confirms that echocardiographic parameters are reliable in predicting PR severity. Combined measurement of diastolic flow reversal in the pulmonary artery branches and PHT is reliable in the detection of severe PR in the follow‐up of TOF patients. |
| doi_str_mv | 10.1111/chd.12762 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6849708</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2188984638</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4432-cf925b333cc16fd91f6c739fa83e7b06ca741c62fcd1bbfdc20f95881ad6821d3</originalsourceid><addsrcrecordid>eNp1kUtr3DAUhUVpaV5d5A8EQzfNYhI9bEneFMo0j0Kgmwa6E9ey5FEqW65kp8y_j5xJQlqoNnrc7x7O1UHomOAzkte53rRnhApO36B9IkqxwhKzt89nUf_cQwcp3WFccibke7THsCwZr6p99OtCb4KG2LrQRRg3ThcjROjNZGIqgi2SuTfRFOPs-zBA3BbRdHPs3ASTC0MBNoNFWl40-FwcwcWlbzJTBB-67XK5BO_DdITeWfDJfHjaD9Ht5cWP9fXq5vvVt_WXm5UuS0ZX2ta0ahhjWhNu25pYrgWrLUhmRIO5BlESzanVLWka22qKbV1JSaDlkpKWHaLPO91xbnrTajMsVtQYXZ8HUAGc-rsyuI3qwr3isqwFllng05NADL9nkybVu6SN9zCYMCdFiZS1zJ-5oB__Qe_CHIc8nqJUMFHRqqoydbqjdAwpRWNfzBCslghVjlA9RpjZk9fuX8jnzDJwvgP-OG-2_1dS6-uvO8kHXfuo7Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2273752555</pqid></control><display><type>article</type><title>Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Tech Science Press</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Van Berendoncks, An ; Van Grootel, Roderick ; McGhie, Jackie ; van Kranenburg, Matthijs ; Menting, Myrthe ; Cuypers, Judith A.A.E. ; Bogers, Ad J.J.C. ; Witsenburg, Maarten ; Roos‐Hesselink, Jolien W. ; van den Bosch, Annemien E.</creator><creatorcontrib>Van Berendoncks, An ; Van Grootel, Roderick ; McGhie, Jackie ; van Kranenburg, Matthijs ; Menting, Myrthe ; Cuypers, Judith A.A.E. ; Bogers, Ad J.J.C. ; Witsenburg, Maarten ; Roos‐Hesselink, Jolien W. ; van den Bosch, Annemien E.</creatorcontrib><description>Aims
Reliable evaluation of the severity and consequences of pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (TOF) is crucial to timely identify the need for pulmonary valve intervention. We aimed to identify the accuracy of echocardiographic parameters to differentiate between moderate and severe PR, using phase contrast cardiac magnetic resonance imaging (CMR) as gold standard.
Methods and results
In this cross‐sectional study, 45 TOF patients with both echocardiographic and CMR measurements of PR were enrolled. All quantitative and semiquantitative echocardiographic measurements such as pressure half time (PHT), Color flow jet width (CFJW), ratio CFJW/right ventricle outflow tract (RVOT) diameter, PR index and the presence of early termination of the PR jet, end‐diastolic antegrade flow and diastolic backflow in main pulmonary artery (MPA), and PA branches correlated significantly with PR fraction on CMR. Qualitative assessment with color flow on echocardiography overestimated PR Multivariate linear regression analysis identified the ratio of CFJW/RVOT diameter and PHT as independent predictors of PR fraction. Accuracy of echo parameters was tested to differentiate between mild‐to‐moderate and severe PR Combining different echocardiographic parameters increased sensitivity and specificity. The addition of diastolic flow reversal in the PA branches to PHT below 167 milliseconds increased the NPV from 87% to 89% and PPV from 62% to 76%.
Conclusions
Comparison with CMR confirms that echocardiographic parameters are reliable in predicting PR severity. Combined measurement of diastolic flow reversal in the pulmonary artery branches and PHT is reliable in the detection of severe PR in the follow‐up of TOF patients.</description><identifier>ISSN: 1747-079X</identifier><identifier>EISSN: 1747-0803</identifier><identifier>DOI: 10.1111/chd.12762</identifier><identifier>PMID: 30843655</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Adult ; Cardiac Surgical Procedures - adverse effects ; Cardiovascular disease ; CMR ; Color ; Congenital diseases ; Cross-Sectional Studies ; Echocardiography ; Echocardiography, Doppler, Color - methods ; Electrocardiography ; Female ; Follow-Up Studies ; Heart surgery ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Magnetic resonance imaging ; Magnetic Resonance Imaging, Cine - methods ; Male ; Middle Aged ; Original ; Parameter identification ; Parameter sensitivity ; Phase contrast ; Postoperative Complications ; Pulmonary arteries ; pulmonary regurgitation ; Pulmonary Valve - diagnostic imaging ; Pulmonary Valve Insufficiency - diagnosis ; Pulmonary Valve Insufficiency - etiology ; Pulmonary Valve Insufficiency - physiopathology ; Qualitative analysis ; Regression analysis ; Retrospective Studies ; Tetralogy of Fallot - diagnosis ; Tetralogy of Fallot - surgery ; Time Factors ; TOF ; Ventricular Function, Right - physiology ; Young Adult</subject><ispartof>Congenital heart disease, 2019-07, Vol.14 (4), p.628-637</ispartof><rights>2019 The Authors. Published by Wiley Periodicals, Inc.</rights><rights>2019 The Authors. Congenital Heart Disease Published by Wiley Periodicals, Inc.</rights><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4432-cf925b333cc16fd91f6c739fa83e7b06ca741c62fcd1bbfdc20f95881ad6821d3</citedby><cites>FETCH-LOGICAL-c4432-cf925b333cc16fd91f6c739fa83e7b06ca741c62fcd1bbfdc20f95881ad6821d3</cites><orcidid>0000-0002-6770-3830 ; 0000-0001-6200-1998</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fchd.12762$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fchd.12762$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30843655$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Van Berendoncks, An</creatorcontrib><creatorcontrib>Van Grootel, Roderick</creatorcontrib><creatorcontrib>McGhie, Jackie</creatorcontrib><creatorcontrib>van Kranenburg, Matthijs</creatorcontrib><creatorcontrib>Menting, Myrthe</creatorcontrib><creatorcontrib>Cuypers, Judith A.A.E.</creatorcontrib><creatorcontrib>Bogers, Ad J.J.C.</creatorcontrib><creatorcontrib>Witsenburg, Maarten</creatorcontrib><creatorcontrib>Roos‐Hesselink, Jolien W.</creatorcontrib><creatorcontrib>van den Bosch, Annemien E.</creatorcontrib><title>Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot</title><title>Congenital heart disease</title><addtitle>Congenit Heart Dis</addtitle><description>Aims
Reliable evaluation of the severity and consequences of pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (TOF) is crucial to timely identify the need for pulmonary valve intervention. We aimed to identify the accuracy of echocardiographic parameters to differentiate between moderate and severe PR, using phase contrast cardiac magnetic resonance imaging (CMR) as gold standard.
Methods and results
In this cross‐sectional study, 45 TOF patients with both echocardiographic and CMR measurements of PR were enrolled. All quantitative and semiquantitative echocardiographic measurements such as pressure half time (PHT), Color flow jet width (CFJW), ratio CFJW/right ventricle outflow tract (RVOT) diameter, PR index and the presence of early termination of the PR jet, end‐diastolic antegrade flow and diastolic backflow in main pulmonary artery (MPA), and PA branches correlated significantly with PR fraction on CMR. Qualitative assessment with color flow on echocardiography overestimated PR Multivariate linear regression analysis identified the ratio of CFJW/RVOT diameter and PHT as independent predictors of PR fraction. Accuracy of echo parameters was tested to differentiate between mild‐to‐moderate and severe PR Combining different echocardiographic parameters increased sensitivity and specificity. The addition of diastolic flow reversal in the PA branches to PHT below 167 milliseconds increased the NPV from 87% to 89% and PPV from 62% to 76%.
Conclusions
Comparison with CMR confirms that echocardiographic parameters are reliable in predicting PR severity. Combined measurement of diastolic flow reversal in the pulmonary artery branches and PHT is reliable in the detection of severe PR in the follow‐up of TOF patients.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Cardiovascular disease</subject><subject>CMR</subject><subject>Color</subject><subject>Congenital diseases</subject><subject>Cross-Sectional Studies</subject><subject>Echocardiography</subject><subject>Echocardiography, Doppler, Color - methods</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart surgery</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging, Cine - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Parameter identification</subject><subject>Parameter sensitivity</subject><subject>Phase contrast</subject><subject>Postoperative Complications</subject><subject>Pulmonary arteries</subject><subject>pulmonary regurgitation</subject><subject>Pulmonary Valve - diagnostic imaging</subject><subject>Pulmonary Valve Insufficiency - diagnosis</subject><subject>Pulmonary Valve Insufficiency - etiology</subject><subject>Pulmonary Valve Insufficiency - physiopathology</subject><subject>Qualitative analysis</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Tetralogy of Fallot - diagnosis</subject><subject>Tetralogy of Fallot - surgery</subject><subject>Time Factors</subject><subject>TOF</subject><subject>Ventricular Function, Right - physiology</subject><subject>Young Adult</subject><issn>1747-079X</issn><issn>1747-0803</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kUtr3DAUhUVpaV5d5A8EQzfNYhI9bEneFMo0j0Kgmwa6E9ey5FEqW65kp8y_j5xJQlqoNnrc7x7O1UHomOAzkte53rRnhApO36B9IkqxwhKzt89nUf_cQwcp3WFccibke7THsCwZr6p99OtCb4KG2LrQRRg3ThcjROjNZGIqgi2SuTfRFOPs-zBA3BbRdHPs3ASTC0MBNoNFWl40-FwcwcWlbzJTBB-67XK5BO_DdITeWfDJfHjaD9Ht5cWP9fXq5vvVt_WXm5UuS0ZX2ta0ahhjWhNu25pYrgWrLUhmRIO5BlESzanVLWka22qKbV1JSaDlkpKWHaLPO91xbnrTajMsVtQYXZ8HUAGc-rsyuI3qwr3isqwFllng05NADL9nkybVu6SN9zCYMCdFiZS1zJ-5oB__Qe_CHIc8nqJUMFHRqqoydbqjdAwpRWNfzBCslghVjlA9RpjZk9fuX8jnzDJwvgP-OG-2_1dS6-uvO8kHXfuo7Q</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Van Berendoncks, An</creator><creator>Van Grootel, Roderick</creator><creator>McGhie, Jackie</creator><creator>van Kranenburg, Matthijs</creator><creator>Menting, Myrthe</creator><creator>Cuypers, Judith A.A.E.</creator><creator>Bogers, Ad J.J.C.</creator><creator>Witsenburg, Maarten</creator><creator>Roos‐Hesselink, Jolien W.</creator><creator>van den Bosch, Annemien E.</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>JQ2</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6770-3830</orcidid><orcidid>https://orcid.org/0000-0001-6200-1998</orcidid></search><sort><creationdate>201907</creationdate><title>Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot</title><author>Van Berendoncks, An ; Van Grootel, Roderick ; McGhie, Jackie ; van Kranenburg, Matthijs ; Menting, Myrthe ; Cuypers, Judith A.A.E. ; Bogers, Ad J.J.C. ; Witsenburg, Maarten ; Roos‐Hesselink, Jolien W. ; van den Bosch, Annemien E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4432-cf925b333cc16fd91f6c739fa83e7b06ca741c62fcd1bbfdc20f95881ad6821d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Cardiovascular disease</topic><topic>CMR</topic><topic>Color</topic><topic>Congenital diseases</topic><topic>Cross-Sectional Studies</topic><topic>Echocardiography</topic><topic>Echocardiography, Doppler, Color - methods</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart surgery</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging, Cine - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Parameter identification</topic><topic>Parameter sensitivity</topic><topic>Phase contrast</topic><topic>Postoperative Complications</topic><topic>Pulmonary arteries</topic><topic>pulmonary regurgitation</topic><topic>Pulmonary Valve - diagnostic imaging</topic><topic>Pulmonary Valve Insufficiency - diagnosis</topic><topic>Pulmonary Valve Insufficiency - etiology</topic><topic>Pulmonary Valve Insufficiency - physiopathology</topic><topic>Qualitative analysis</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Tetralogy of Fallot - diagnosis</topic><topic>Tetralogy of Fallot - surgery</topic><topic>Time Factors</topic><topic>TOF</topic><topic>Ventricular Function, Right - physiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Van Berendoncks, An</creatorcontrib><creatorcontrib>Van Grootel, Roderick</creatorcontrib><creatorcontrib>McGhie, Jackie</creatorcontrib><creatorcontrib>van Kranenburg, Matthijs</creatorcontrib><creatorcontrib>Menting, Myrthe</creatorcontrib><creatorcontrib>Cuypers, Judith A.A.E.</creatorcontrib><creatorcontrib>Bogers, Ad J.J.C.</creatorcontrib><creatorcontrib>Witsenburg, Maarten</creatorcontrib><creatorcontrib>Roos‐Hesselink, Jolien W.</creatorcontrib><creatorcontrib>van den Bosch, Annemien E.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Computer Science Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Congenital heart disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Van Berendoncks, An</au><au>Van Grootel, Roderick</au><au>McGhie, Jackie</au><au>van Kranenburg, Matthijs</au><au>Menting, Myrthe</au><au>Cuypers, Judith A.A.E.</au><au>Bogers, Ad J.J.C.</au><au>Witsenburg, Maarten</au><au>Roos‐Hesselink, Jolien W.</au><au>van den Bosch, Annemien E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot</atitle><jtitle>Congenital heart disease</jtitle><addtitle>Congenit Heart Dis</addtitle><date>2019-07</date><risdate>2019</risdate><volume>14</volume><issue>4</issue><spage>628</spage><epage>637</epage><pages>628-637</pages><issn>1747-079X</issn><eissn>1747-0803</eissn><abstract>Aims
Reliable evaluation of the severity and consequences of pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (TOF) is crucial to timely identify the need for pulmonary valve intervention. We aimed to identify the accuracy of echocardiographic parameters to differentiate between moderate and severe PR, using phase contrast cardiac magnetic resonance imaging (CMR) as gold standard.
Methods and results
In this cross‐sectional study, 45 TOF patients with both echocardiographic and CMR measurements of PR were enrolled. All quantitative and semiquantitative echocardiographic measurements such as pressure half time (PHT), Color flow jet width (CFJW), ratio CFJW/right ventricle outflow tract (RVOT) diameter, PR index and the presence of early termination of the PR jet, end‐diastolic antegrade flow and diastolic backflow in main pulmonary artery (MPA), and PA branches correlated significantly with PR fraction on CMR. Qualitative assessment with color flow on echocardiography overestimated PR Multivariate linear regression analysis identified the ratio of CFJW/RVOT diameter and PHT as independent predictors of PR fraction. Accuracy of echo parameters was tested to differentiate between mild‐to‐moderate and severe PR Combining different echocardiographic parameters increased sensitivity and specificity. The addition of diastolic flow reversal in the PA branches to PHT below 167 milliseconds increased the NPV from 87% to 89% and PPV from 62% to 76%.
Conclusions
Comparison with CMR confirms that echocardiographic parameters are reliable in predicting PR severity. Combined measurement of diastolic flow reversal in the pulmonary artery branches and PHT is reliable in the detection of severe PR in the follow‐up of TOF patients.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30843655</pmid><doi>10.1111/chd.12762</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-6770-3830</orcidid><orcidid>https://orcid.org/0000-0001-6200-1998</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Cardiac Surgical Procedures - adverse effects Cardiovascular disease CMR Color Congenital diseases Cross-Sectional Studies Echocardiography Echocardiography, Doppler, Color - methods Electrocardiography Female Follow-Up Studies Heart surgery Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Magnetic resonance imaging Magnetic Resonance Imaging, Cine - methods Male Middle Aged Original Parameter identification Parameter sensitivity Phase contrast Postoperative Complications Pulmonary arteries pulmonary regurgitation Pulmonary Valve - diagnostic imaging Pulmonary Valve Insufficiency - diagnosis Pulmonary Valve Insufficiency - etiology Pulmonary Valve Insufficiency - physiopathology Qualitative analysis Regression analysis Retrospective Studies Tetralogy of Fallot - diagnosis Tetralogy of Fallot - surgery Time Factors TOF Ventricular Function, Right - physiology Young Adult |
| title | Echocardiographic parameters of severe pulmonary regurgitation after surgical repair of tetralogy of Fallot |
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