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Quantitative Assessment of Contractile Reserve of Systemic Right Ventricle in Post-Senning Children: Incorporating Speckle-tracking Strain and Dobutamine Stress Echocardiography
  • Fatma Taha
Fatma Taha
Tanta University Faculty of Medicine
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Introduction: The systemic load on the right ventricle (RV) after Senning atrial switch leads to ventricular dysfunction. Quantitative assessment of RV contractile reserve is mandatory to anticipate the need for anti-failure treatment. We aimed to quantitatively assess RV contractile reserve in Senning children by interrogating speckled global longitudinal strain (GLS) during dobutamine stress echocardiography (DSE). Methods: This prospective study compared thirty-one post-Senning children (group I), and thirty controls (group II). In post-Senning children, echocardiographic RV systolic function using automated Simpson’s one-plane ejection fraction (RVEF), tricuspid annulus plane systolic excursion (TAPSE), and RVGLS were recorded at rest and at peak DSE. The contractile reserve was defined as improvement >5% in RVEF, >2% in GLS, and/or to near normal values in TAPSE. Results: RVEF, and TAPSE were significantly lower in patients than controls (RVEF: 40.13±2.93% vs. 53.17±3.17% respectively, P<0.001*, TAPSE: 13.81±1.26 vs. 17.45±2.93 mm respectively, P<0.001*). Also, RVGLS was significantly worse in Senning children than controls (-11.89±2.31% vs. -22.35±6.73% respectively, P<0.001*). At peak DSE, contractile reserve was not evident as measured by RVEF which increased none significantly to 42.47±2.80% (P=0.063). However, RVGLS improved significantly to -15.78±0.93% (P<0.001*) and discovered the masked contractile reserve in Senning children. The 19(61.29%) children who showed masked contractile reserve (improvement in RVGLS>2%) underwent continuation of anti-failure medications. Conclusions: Despite systemic RV function in post-Senning children was impaired at rest and during DSE, RVGLS was useful in quantitative assessment of masked contractile reserve that was not evaluated by the ordinary RVEF, thus promoted continuing anti-failure treatment.

Peer review status:Published

26 Jun 2020Submitted to Echocardiography
27 Jun 2020Submission Checks Completed
27 Jun 2020Assigned to Editor
27 Jun 2020Reviewer(s) Assigned
24 Sep 2020Review(s) Completed, Editorial Evaluation Pending
25 Sep 2020Editorial Decision: Revise Minor
04 Oct 20201st Revision Received
06 Oct 2020Submission Checks Completed
06 Oct 2020Assigned to Editor
06 Oct 2020Reviewer(s) Assigned
22 Oct 2020Review(s) Completed, Editorial Evaluation Pending
25 Oct 2020Editorial Decision: Accept
16 Nov 2020Published in Echocardiography. 10.1111/echo.14924