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European Radiology
Published in: European Radiology 10/2018

Open Access 01-10-2018 | Cardiac

Disturbed left and right ventricular kinetic energy in patients with repaired tetralogy of Fallot: pathophysiological insights using 4D-flow MRI

Authors: Pia Sjöberg, Sebastian Bidhult, Jelena Bock, Einar Heiberg, Håkan Arheden, Ronny Gustafsson, Shahab Nozohoor, Marcus Carlsson

Published in: European Radiology | Issue 10/2018

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Abstract

Objectives

Indications for pulmonary valve replacement (PVR) in patients with pulmonary regurgitation (PR) after repaired tetralogy of Fallot (rToF) are debated. We aimed to compare right (RV) and left ventricular (LV) kinetic energy (KE) measured by 4D-flow magnetic resonance imaging (MRI) in patients to controls, to further understand the pathophysiological effects of PR.

Methods

Fifteen patients with rToF with PR > 20% and 14 controls underwent MRI. Ventricular volumes and KE were quantified from cine MRI and 4D-flow, respectively. Lagrangian coherent structures were used to discriminate KE in the PR. Restrictive RV physiology was defined as end-diastolic forward flow.

Results

LV systolic peak KE was lower in rToF, 2.8 ± 1.1 mJ, compared to healthy volunteers, 4.8 ± 1.1 mJ, p < 0.0001. RV diastolic peak KE was higher in rToF (7.7 ± 4.3 mJ vs 3.1 ± 1.3 mJ, p = 0.0001) and the difference most pronounced in patients with non-restrictive RV physiology. KE was primarily located in the PR volume at the time of diastolic peak KE, 64 ± 17%.

Conclusion

This is the first study showing disturbed KE in patients with rToF and PR, in both the RV and LV. The role of KE as a potential early marker of ventricular dysfunction to guide intervention needs to be addressed in future studies.

Key Points

• Kinetic energy (KE) reflects ventricular performance
• KE is a potential marker of ventricular dysfunction in Fallot patients
• KE is disturbed in both ventricles in patients with tetralogy of Fallot
• KE contributes to the understanding of the pathophysiology of pulmonary regurgitation
• Lagrangian coherent structures enable differentiation of ventricular inflows
Appendix
Available only for authorised users
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Metadata
Title
Disturbed left and right ventricular kinetic energy in patients with repaired tetralogy of Fallot: pathophysiological insights using 4D-flow MRI
Authors
Pia Sjöberg
Sebastian Bidhult
Jelena Bock
Einar Heiberg
Håkan Arheden
Ronny Gustafsson
Shahab Nozohoor
Marcus Carlsson
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5385-3

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Correction to: Reference ranges of left ventricular structure and function assessed by contrast-enhanced cardiac MR and changes related to ageing and hypertension in a population-based study