الفهرس 
Speckle tracking EchocardiographyOnly 14 pages are availabe for public view
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Abstract
In congenital heart disease assessment of right ventricular
function remains challenging. Global function and the role of
regional differences during the progression of myocardial
dysfunction needs to be defined, so the present study was
performed to study the effect of pulmonary stenosis on RV
speckle tracking derived Indices and compare them to the usual
٢D parameters.
The study included ١٦٠ patients, ١٠٠ with moderate or
severe pulmonary stenosis who were referred for balloon
pulmonary valvuloplasty to Ain Shams university hospital and
٦٠ control subjects referred to perform echocardiography in Ain
shams university echocardiography unit from January ٢٠١٢ to
July ٢٠١٣.
All the patients included in the study performed full
echocardiographic examination and speckle tracking analysis
before BPV and three months after BPV.
The patients included ٥٢ females (٥٢ %) and ٤٨ males
(٤٨ %) with a median age of ١٫٥ years (range from ٢ months to
٦٠ years).
The fractional area change increased after successful
BPV, the mean FAC before BPV was ٣٣٫٦ % ± ٨٫٧٨ %which
increased to ٤٢٫٢٪ ± ٩٪ after BPV.The peak pressure gradient across the PV dropped from
٨٠٫٨ ± ٢٢٫٩ mm Hg to ٢٦٫٩ ± ٨٫٩ mm Hg after BPV.
The RV longitudinal dimension decreased after
successful BPV from ٣٦٫١ mm ± ٨٫٨ mm to ٣٢٫٦ ± ٨٫٣ mm.
The RV transverse dimension decreased after BPV from
٢١٫٥ ± ٥٫٧ mm to ١٩٫٩ ± ٥٫٦ mm.
The TAPSE increased after BPV from ١٫٦٨ ± ٠٫٤٢ cm to
١٫٩٥ ± ٠٫٣٢ cm.
The RV wall thickness decreased after BPV from ٥٫٢
mm ± ١٫٦ mm to ٤٫٠٦ ± ١٫٣ mm.
The pressure gradient across the PV obtained by catheter
pull back decreased after successful BPV from ٧٨٫١ ± ٢٢
mmHg to ١٨٫٤ ± ٦٫٧٥ mmHg.
Out of ١٠٠ patients ٩٦ % (٩٦ patients) were properly
analyzed by the STE software where only ٤ patients were
rejected by the software and were not analyzed.
The segmental and global RV strain increased after BPV,
the global RV strain increased after BPV from -١٩٫٨ ± ٤٫٧٤ %
to -٢٤٫٣٧ ± ٣٫٥٧ %, this increase was statistically significant
with a P value of < ٠٫٠٠٠١.
The segmental and global right ventricular strain rate
increased after BPV, the global RV strain rate increased after BPV from -٢٫٤١ ± ٠٫٦٦ % to -٣٫٨٥ ± ٠٫٥١ %, this increase was
statistically significant with a P value of < ٠٫٠٠٠١.
The time to peak systolic strain was shorter in all the
segments after BPV.
٩٣٪ (n=٥٦) of the control subjects were properly
analyzed by the STE software where ٦٫٧٪ (٤ controls) of the
control subjects were rejected by the software.
The FAC was higher among control subjects as
compared to patients with PS where it was ٤١٫٣ ± ٥٫٩ % among
controls versus ٣٣٫٦ ± ٨٫٧٨ % among PS patients; this
difference was statistically significant with a P value < ٠٫٠٠٠١
TAPSE was higher in control subjects as compared to
patients with PS where it measured ١٫٦٨ ± ٠٫٤٢ cm in patients
with PS as compared to ٢٫١ ± ٠٫٣٣ cm in control subjects; this
difference was statistically significant with a P value of < ٠٫٠٠٠١.
The RV wall was thicker in patients with PS where it
measured ٥٫٢ ± ١٫٦ mm in patients with PS as compared to ٣٫٥
± ٠٫٦ mm in control subjects; this difference was statistically
significant with a P value of < ٠٫٠٠٠١.
The FAC in patients after BPV was slightly higher than
control subjects, where it measured ٤٢٫٢ ± ٩ % in patients
versus ٤١٫٣ ± ٥٫٩ % in controls; the difference was not
statistically significant. The RV longitudinal dimension measured after BPV was
very close to that measured in control subjects, where it
measured ٣٢٫٦ ± ٨٫٣ mm in patients as compared to ٣٤٫٤ ± ٨٫٢
mm; the difference was not statistically significant.
The TAPSE was higher among controls as compared to
patients after BPV, TAPSE among controls was ٢٫١ ± ٠٫٣ cm
and was ١٫٩ ± ٠٫٣ cm among patients, and the difference was
statistically significant with a P value of ٠٫٠٠٠١.
The RV wall was thicker in patients with PS after BPV as
compared to controls, the difference was statistically significant
with RV wall thickness of ٤ ± ١٫٣ mm in patients versus ٣٫٥±
٠٫٦ mm, and the P value was ٠٫٠٠٢.
The global RV strain was higher in controls as compared
to PS patients, it was -١٩٫٨ ± ٤٫٧ % in PS patients versus -٢٣٫٢
± ٢٪, and this difference was statistically significant, P value of
< ٠٫٠٠٠١.
The segmental and global RV strain rate was higher in
control subjects as compared to PS patients, this applied for all
the segments as well as the global RV strain rate and was
statistically significant with a P value <٠٫٠٠٠١.
The segmental time to peak strain showed that all
segments of the RV in patients with pulmonary stenosis had
longer time to peak systolic strain as compared to controls, this
difference was statistically significant for all segments (P value < ٠.٠٥) except for the mid septal time to peak strain which was
longer in PS patients but was not statistically significant.
The study concluded that speckle tracking echocardiography
can be used to detect subtle changes in RV deformation and the
effect of pressure overload on regional RV function in patients with
pulmonary stenosis.