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Showing 8 results for Echocardiography
A Malakan Rad, N Momtazmanesh,
Volume 8, Issue 27 (3-2002)
Volume 8, Issue 27 (3-2002)
Abstract
ABSTRACT Due to the frequency of major thalassemia in our country and cardiac complications secondry to iron overload as one of the most important causes of death in these patients and the absence of any similar study in this region (Kashan city), we studied the cardiac complications in patients with major thalassemia in Kashan in 1999 and 2000. A prospective descriptive study was performed on seventeen patients with major thalassemia. All patients underwent a thorough noninvasive cardiovascular investigation including history taking, physical examination, electrocardiography (ECG), chest roentgenography (CXR) and complete two-dimensional, color M-Mode Doppler echocardiography. Arterial blood pressure and indices of diastolic function by Doppler echocardiography were measured in seventeen age and sex-matched healthy individuals as control group. The obtained data were recorded and standard deviation was calculated. P value less than 0.05 was considered as significant. A study was carried out on seventeen patients (including eleven male and six female) with the age range of 18 months to 25 years old (mean 14 years). Weakness and easy fatiguabiltiy were the most common complaints in the history of patients. In all patients arterial blood pressure was between the 5% and 25% for height, sex and age (significantly lower than the control group) ECG and cardiac size in CXR were normal in 82% and 76% of patients respectively. Abnormal findings in the ECG included left ventricular hypertrophy in two patients and first degree atrioventericular block (not present in the ECG of the same patient at six months ago) in one of the cases. Diastolic and systolic dysfunction were observed in 82% and 11% of cases respectively, by echocardiography. Diastolic dysfunction occurs earlier than systolic dysfunction in patients with major thalassemia and electrocardiography and chest X-Ray are not sensitive tools for early detection of diastolic dysfunction in these patients. Echocardiogarphy is the best noninvasive means for evaluation of ventricular function particularly diastolic function and is recommended for early detection of cardiac complications in these patients.
D. Farsi,, M. Mofidi,, N. Kianmehr,, S. Abbasi,, M.a. Zare,, H. Shaker,, M. Rezaee, N. Ashayeri,
Volume 15, Issue 0 (9-2008)
Volume 15, Issue 0 (9-2008)
Abstract
Background & Aim:
departments. Low risk patients can be discharged and receive outpatient treatment if clinical and paraclinical assays are
normal. The recommended pre-discharge evaluations are controversial. However, because of the availability and safety of
bedside echocardiography in emergency departments, we decided to conduct this study.
Unstable angina accounts for about 30% of cardiovascular patients referred to emergencyPatients and Method:
unstable angina and admitted to the Emergency Department of Hazrat Rasoul-e-Akram Hospital. All of the cases
underwent bedside echocardiography before their discharge. Calling the patients one month after their discharge, their
outcomes were recorded. Then we made a comparison between echocardiographic findings and their one-month
outcomes. The data were analyzed via SPSS software using statistical tests such as Fisher, Chi-square and t-test.
This cohort study was done on 140 patients with chest pain who were diagnosed with low riskResults:
cases) were male. The patients with abnormal echocardiographic findings, i.e. EF(Ejection Fraction)<40% and wall motion
abnormality, had a significantly higher rate of re-hospitalization because of chest pain(p=0.000).
The mean age of the patients was 51.39(SD=10.13) years. 42.1%(59 cases) were female and 57.9%(81Conclusion:
cardiovascular events in low risk unstable angina patients.
The study shows that bedside echocardiography before discharge is a reliable method for predicting
, , , ,
Volume 22, Issue 139 (1-2016)
Volume 22, Issue 139 (1-2016)
Abstract
Background: Cardiac tumors are usually asymptomatic diseases. Considering the anatomic position of the heart, it is necessary to identify their nature before every aggressive intervention. The aim of this study was to compare the diagnostic performance of MRI and transthoracic echocardiography (TTE) assessment of cardiac masses. Methods: In a cross-sectional survey from April 2010 to March 2013, twenty eight patients with suspected cardiac tumors, were evaluated with TTE and MRI. Collected data analyzed using MCSS 2007 and PASS 2008 software p<0.05 used for significance. Results: The present study indicated that accurate diagnosis was made by MRI as 37.9% non-neoplastic lesions, 20.7% as benign tumors, 20.7% as malignant tumors and 3 cases of extra-cardiac lesions. In contrast, only in 8 patients with benign tumors the accurate diagnosis was made by TTE. Conclusion: The present study indicated that MRI scanning in comparison to TTE is more efficacious for the evaluation of cardiac masses and can be considered as an appropriate test when they are suspected according to preliminary results of imaging studies.
Roya Isa Tafreshi, Nahid Rahimzadeh, Rozita Hoseini,
Volume 27, Issue 8 (10-2020)
Volume 27, Issue 8 (10-2020)
Abstract
Background: Cardiovascular disease (CVD) is an important, leading cause of mortality and morbidity in patients with chronic kidney disease (CKD) as well as in renal transplant recipients. Cardiovascular complications become more important in children because of the improved life span of children after kidney transplantation (KT). Recent research programs are looking into the initial stages of renal failure to diagnose early and subclinical cardiac impairment. It has been shown that abnormalities in LV geometry which start early during renal impairment are one of the key mechanisms for developing progressive cardiac complications. Despite improving LV function following KT, cardiac complications are still defined as the main risk factor for mortality in renal recipients. New echocardiographic techniques using Tissue Doppler Imaging (TDI) have been proven to be sensitive and accurate methods for recognizing the initial phase of ventricular dysfunction in a variety of diseases. To our knowledge, there is a little information on severity of cardiac involvement including structural and functional changes in children with KT who have a short duration of renal impairment. This study aimed to evaluate ventricular systolic and diastolic functions by using TDI parameters in a group of post-transplant children who had no symptoms of heart failure before KT.
Methods: Clinical and echocardiographic data were prospectively obtained from 18 patients with CKD before kidney transplantation. The inclusion criteria consisted of the following: (1) age under 18 years old, (2) no limitation in ordinary physical activities (NYHA functional class I), (3) LV ejection fraction ≥ 55%, and (4) absence of co-existing disease. The transthoracic echocardiographic study was performed within 3 months before the transplantation by an experienced physician, who was unaware of the status of the subjects. All patients of the study were followed up, and the post-transplant data were obtained during one to three years. The obtained echocardiographic data were analyzed and compared with the control group consisting of 37 age-matched, healthy children. LV hypertrophy (LVH) was defined as LV mass index >51 g/m2.7. LV systolic function was assessed by measuring ejection fraction (LVEF) using modified Simpson’s method. Tissue Doppler Imaging was used for the assessment of both systolic and diastolic LV functions, and the TDI derived MPI (TDI-MPI) was considered to be a marker of global LV function. In addition, tissue Doppler derived parameters were used for assessing regional longitudinal performances of the left ventricle. Peak early diastolic velocity (e’), peak late diastolic velocity (a’), and peak systolic velocity (s’) were obtained from the septal and lateral sides of the mitral annulus. According to the current guidelines, we evaluated the diastolic function by calculating E/e´ ratio.
Results: The mean age at KT was 12.2+2 years. Five patients received maintenance dialysis before KT. Median follow-up after KT was 2.3 (1.3-3) years.
LVEF was within the normal range for all of the patients. LV mass decreased significantly after KT (51 ± 1.5g/m2.7 vs. 43.1±1.6 g/m2.7، p<0.05), but it was still greater than the controls (p<0.05). LVH was found in 8(44%) patients. We observed a positive correlation between pre-transplant hypertension and post-transplant LVMI (r=0.41, p<0.05).
The TDI-MPI, as a marker of global LV function, was significantly greater in the post-transplantation patients than that in control group (0.36 ± 0.13 vs. 0.31 ± 0.01, p <0.05). Using ROC curve analysis, the TDI-MPI yielded an area under the curve of 0.86 to discriminate the patients against those without subclinical LV dysfunction. Using a TDI-MPI > 0.32 as the cut point, LV dysfunction was identified with a sensitivity of 75% and specificity of 48%. We observed a significant correlation between the values of TDI-MPI and the presence of LVH before transplantation (r=0.4, p<0.05).
Regarding the LV longitudinal systolic function, the myocardial systolic velocity (s´) was significantly different between the post-transplantation patients and the ones in the control group (6.5 ± 0.9cm/s vs. 7.3±0.7cm/s, p<0.05), while the myocardial diastolic velocities did not differ between them. Moreover, an inverse relationship was observed between the values of s´ wave velocity and LVMI (r= -0.46, p<0.05). This association is in favor of the potential role of LV remodeling on the reduced longitudinal function of the myocardium. None of the patients had a ratio of E/e’> 14 as an index of high LV filling pressure. The values of E/e ratio were correlated to LV end- diastolic and systolic diameters (r= 0.36, r= 0.34, p<0.05, respectively). There was no relationship between E/e’ ratio and LV mass.
Conclusion: Assessment of the LV function with accurate echocardiographic methods showed subtle LV dysfunction in patients who were asymptomatic for heart failure and with a short pre-transplant duration of renal impairment. Moreover, LVH was the most commonly observed cardiac abnormality in post-transplant pediatric patients.
In concordance with previous studies, we found that the restoration of renal function by renal transplantation improved global ventricular function and also reduced the LV mass. (7,8) However, a higher LV mass was often present in KT patients and may lead to a poor outcome. (2) Furthermore, the LV longitudinal systolic function, assessed by measurement of s’ wave velocity, improved significantly after KT. Our findings regarding a correlation of elevated LV mass with both of the TDI-MPI and impaired systolic indices of myocardial function highlight the basic role of LV remodeling on myocardial dysfunction even in the subgroup of the patients with a short period of renal failure. Moreover, its association with pre-transplant hypertension suggests that more complete control of the blood pressure in CKD patients is important for reducing cardiac risk factors.
Subtle abnormalities of the LV systolic- diastolic function and LVH are present in children after renal transplantation who have no symptoms for heart failure within the pre-transplant period. Although our study is limited by the small group of the patients, the data might imply that high LV mass may substantially influence the post-transplant cardiac function. These findings confirm the importance of early initiation of therapeutic interventions to modify permanent cardiac dysfunction.
Reza Gerami, Ali Salehi,
Volume 29, Issue 3 (5-2022)
Volume 29, Issue 3 (5-2022)
Abstract
Background & Aims: Artificial intelligence (AI) plays an important role in the development of echocardiography for fetal heart disorders. Artificial intelligence, especially deep learning, has shown significant capabilities in reducing the time required for echocardiographic examinations, increasing diagnostic accuracy, and helping to identify anatomical changes and abnormalities in the fetal heart. In the field of fetal heart and blood vessels, artificial intelligence promises to improve prenatal diagnosis of congenital heart disease. This offers the potential to improve screening processes that lead to early diagnosis and intervention in cases of fetal heart disorders. Smart diagnosis based on echocardiography, along with artificial intelligence techniques such as heart segmentation and identification of standard heart parts, helps in more effective and accurate diagnosis. The integration of artificial intelligence in the perinatal diagnosis of congenital heart disease shows its application in improving diagnostic accuracy with continuous efforts in research to further increase its effectiveness. Prenatal diagnosis of congenital heart disease (CHD) in medicine seems to be a solved problem, although challenges continue. Factors affecting fetal congenital heart diseases (CHDs) are diverse and available data in this field are limited. A study of fetal circulatory physiology and brain development in individuals with fetal congenital heart disease provides valuable insights. Advances in prenatal management and intervention for congenital heart disease are the subject of ongoing research that discusses current knowledge, implications, and challenges. Additionally, ongoing investigations such as blood tests to detect dangerous fetal heart defects before birth show promising advances in diagnostic techniques. Over the past decade, there have been significant advances in the prenatal diagnosis of congenital heart defects. While the rate of prenatal diagnosis has increased significantly, some malformations with 3 abnormal vessels are challenging to identify prenatally. Advances in prenatal diagnostic techniques, such as fetal echocardiography, have played an important role in increasing the accuracy of assessing structural heart lesions and dysrhythmic mechanisms. The use of fetal echocardiography has contributed to the growing trend of prenatal diagnosis of congenital heart disease and highlights the impact of evolving diagnostic technologies. The majority of defects identified in fetal life are atrial and ventricular septal defects, and advances continue to address challenges in detecting minor defects. An analysis of the types and trends of prenatally diagnosed fetal heart disorders in the last decade provides insights into the prevalence and characteristics of different types of fetal heart disorders. The purpose of this review study is to evaluate how new technologies can improve the ability of echocardiography to diagnose fetal heart defects.
Methods: In order to thoroughly examine the effects of new technologies on the diagnostic capacities of fetal echocardiography, a full narrative review was conducted using a systematic methodology. We conducted an extensive literature search using well-known academic databases such as Web of Science, ScienceDirect, Scopus, Springer, and Google Scholar. The search approach included targeted keywords pertaining to fetal echocardiography, cutting-edge technology, and enhancements in diagnostics. In order to promote inclusion, we conducted a systematic search of national databases such as the Scientific Information Database (SID), NoorMags, Magiran, and the Islamic World Science Citation Database (ISC) to identify relevant works. The search criteria were limited to papers published until January 2023, encompassing both English and Persian language articles.
Results: In the field of fetal echocardiography, machine learning (ML) brings significant improvements through its application in automated measurements. ML algorithms are effective in automating the measurement of cardiac biometrics and provide accurate assessment of fetal heart structures such as heart chambers. This not only increases efficiency but also ensures accuracy and helps sonographers achieve reliable measurements. Beyond biometrics, ML plays an important role in quality control by evaluating fetal telemedicine audio-visual systems (FTAS) through score-based systems. In addition, ML helps assess the learning curves of sonographers and ensures the quality and consistency of fetal echocardiographic examinations. The versatility of ML programs is evident in fully automated fetal lung ultrasound analysis and shows its ability to deal with various aspects of fetal health monitoring. Additionally, ML is important in hemodynamic quantification, with integrated and automated tools that use ML algorithms to quantify clinically relevant parameters such as B-mode-based pressure and pulse-wave Doppler hemodynamics. These advances underscore the transformative impact of ML in increasing the accuracy, efficiency, and comprehensiveness of fetal echocardiography. Computerized examinations in fetal echocardiography have made significant progress through the integration of machine learning. Studies suggest deep learning-based computer systems for automated echocardiographic examination of the fetal heart. These systems use ML algorithms to predict standard fetal heart shapes, views, and sections, providing valuable insights into congenital heart defects. FetalNet, a deep learning model, improves the detection of congenital heart disease using computer-aided segmentation of standard heart views. In addition, artificial intelligence has shown potential in improving prenatal diagnosis of congenital heart disease and contributing to better prenatal care. The use of deep learning for real cardiac object detection demonstrates the powerful capabilities of computer-aided ML methods in fetal echocardiographic analysis. This investigation demonstrates that STIC, functioning as a dynamic 3D imaging method, enables the ongoing capture of volumetric data from the fetal heart, providing accurate and detailed pictures of cardiac structures and arteries. The incorporation of machine learning (ML) in fetal echocardiography improves the precision of biometric measures, since artificial intelligence systems are skilled at detecting congenital heart abnormalities using conventional images. Moreover, the application of automated assessments and deep learning displays their potential to carefully examine fetal cardiac systems. This integration of technology enables researchers and medical personnel to do more accurate and thorough assessments of fetal cardiac well-being.
Conclusion: The results clearly demonstrate that using modern technology in fetal echocardiography not only enhances diagnostic processes but also has a crucial impact on enhancing treatment and effectively managing fetal cardiac diseases. The integration of imaging technology and artificial intelligence has significant potential for improving diagnostic standards, therefore raising the overall quality of fetal care. The results emphasize the potential revolutionary influence of these technologies on the domain of fetal echocardiography.
Methods: In order to thoroughly examine the effects of new technologies on the diagnostic capacities of fetal echocardiography, a full narrative review was conducted using a systematic methodology. We conducted an extensive literature search using well-known academic databases such as Web of Science, ScienceDirect, Scopus, Springer, and Google Scholar. The search approach included targeted keywords pertaining to fetal echocardiography, cutting-edge technology, and enhancements in diagnostics. In order to promote inclusion, we conducted a systematic search of national databases such as the Scientific Information Database (SID), NoorMags, Magiran, and the Islamic World Science Citation Database (ISC) to identify relevant works. The search criteria were limited to papers published until January 2023, encompassing both English and Persian language articles.
Results: In the field of fetal echocardiography, machine learning (ML) brings significant improvements through its application in automated measurements. ML algorithms are effective in automating the measurement of cardiac biometrics and provide accurate assessment of fetal heart structures such as heart chambers. This not only increases efficiency but also ensures accuracy and helps sonographers achieve reliable measurements. Beyond biometrics, ML plays an important role in quality control by evaluating fetal telemedicine audio-visual systems (FTAS) through score-based systems. In addition, ML helps assess the learning curves of sonographers and ensures the quality and consistency of fetal echocardiographic examinations. The versatility of ML programs is evident in fully automated fetal lung ultrasound analysis and shows its ability to deal with various aspects of fetal health monitoring. Additionally, ML is important in hemodynamic quantification, with integrated and automated tools that use ML algorithms to quantify clinically relevant parameters such as B-mode-based pressure and pulse-wave Doppler hemodynamics. These advances underscore the transformative impact of ML in increasing the accuracy, efficiency, and comprehensiveness of fetal echocardiography. Computerized examinations in fetal echocardiography have made significant progress through the integration of machine learning. Studies suggest deep learning-based computer systems for automated echocardiographic examination of the fetal heart. These systems use ML algorithms to predict standard fetal heart shapes, views, and sections, providing valuable insights into congenital heart defects. FetalNet, a deep learning model, improves the detection of congenital heart disease using computer-aided segmentation of standard heart views. In addition, artificial intelligence has shown potential in improving prenatal diagnosis of congenital heart disease and contributing to better prenatal care. The use of deep learning for real cardiac object detection demonstrates the powerful capabilities of computer-aided ML methods in fetal echocardiographic analysis. This investigation demonstrates that STIC, functioning as a dynamic 3D imaging method, enables the ongoing capture of volumetric data from the fetal heart, providing accurate and detailed pictures of cardiac structures and arteries. The incorporation of machine learning (ML) in fetal echocardiography improves the precision of biometric measures, since artificial intelligence systems are skilled at detecting congenital heart abnormalities using conventional images. Moreover, the application of automated assessments and deep learning displays their potential to carefully examine fetal cardiac systems. This integration of technology enables researchers and medical personnel to do more accurate and thorough assessments of fetal cardiac well-being.
Conclusion: The results clearly demonstrate that using modern technology in fetal echocardiography not only enhances diagnostic processes but also has a crucial impact on enhancing treatment and effectively managing fetal cardiac diseases. The integration of imaging technology and artificial intelligence has significant potential for improving diagnostic standards, therefore raising the overall quality of fetal care. The results emphasize the potential revolutionary influence of these technologies on the domain of fetal echocardiography.
Ali Mazori, Mohammad Radgodarzi, Mahboubeh Kamali, Pegah Taherifar, Ehsan Jahani,
Volume 30, Issue 5 (8-2023)
Volume 30, Issue 5 (8-2023)
Abstract
Background & Aims: Patent ductus arteriosus (PDA) is one of the congenital disorders in premature neonates, which is strongly associated with increased mortality in them. Currently, echocardiography is the method of choice for detecting PDA, and due to the high cost of this method and its lack of easy access, finding a suitable and low-cost alternative method, including the use of clinical parameters to quickly detect PDA in premature neonates and determine the cases in need Treatment is very important. Therefore, in this study, we decided to investigate the sensitivity and specificity of clinical criteria in the diagnosis of PDA in comparison with the echocardiography method.
Preterm neonates refer to neonates who are born before 37 weeks from the first day of the last menstrual period (1) due to developmental delay and also weakness in the immune system, these neonates are about 40 times more than neonates with normal weight at risk of mortality (2). The ductus arteriosus is a vein that connects the pulmonary artery to the aorta. This duct is the fetal vascular connection between the pulmonary artery and the aorta artery, which diverts blood from the pulmonary bed to the systemic circulation during the fetal period (3). In the uterus, blood is shunted from the lungs due to the high pressure in the lungs. Therefore, the blood leaves the right ventricle, enters the ductus arteriosus, and from there enters the aorta (4). The ductus arteriosus contracts after birth and usually closes within 72 hours after birth. If this active contraction does not occur after birth, the ductus arteriosus will remain open. Usually, within 10 to 15 hours after birth, this contraction causes the functional closure of the ductus arteriosus, which starts from the side of the pulmonary artery and finally progresses to the end of the aorta (5). Therefore, keeping this duct open causes the oxygen-rich blood in the aorta to mix with the deoxygenated blood flowing in the pulmonary artery. Therefore, a lot of blood is transferred to the lungs, which increases the pressure on the heart, increases the blood pressure in the pulmonary veins, and also impairs the ventilation of the lungs (6). A large blood shunt from the ductus arteriosus increases pulmonary blood flow and also decreases systemic blood flow (7). Neonates with reduced systemic blood circulation are exposed to dangerous complications such as increased systolic and diastolic pressure, increased oxygen demand, pulmonary edema, tachycardia, active pericardium, heart failure, intracerebral hemorrhage, pulmonary hemorrhage, and necrotizing enterocolitis (8).
Methods: This cross-sectional study was conducted on preterm neonates with PDA and preterm neonates without PDA who were admitted to the NICU department of Akbarabadi Hospital in Tehran during 2017 and 2018. In this study, 124 preterm neonates with a gestational age of 25 to 37 weeks were included in the study. Preterm neonates with convulsions, life-threatening infections, clinical or radiographic evidence of necrotizing enterocolitis, evidence of hemorrhage, congenital neurological disorders, metabolic and genetic syndromes, pulmonary hypoplasia syndrome, congenital heart anomalies, and other fatal abnormalities. , were excluded from the study. Also, a checklist was provided in which case and demographic information related to preterm neonates was recorded. Parameters such as birth age, height and weight, gender, duration of hospitalization in NICU, duration of mechanical ventilation, history of any underlying or congenital disease (such as heart and lung disease, sepsis, other infectious diseases, diseases respiratory, history of cardiac arrest, etc.), neurological diseases, type of birth (NVD or cesarean section), gestational age, mothers' age were also recorded. After initial examinations and selection of patients based on inclusion and exclusion criteria, various clinical parameters in newborns including heart rate, peripheral pulse status, precordial pulse status, heart murmur status, cardiothoracic ratio, first minute Apgar score and Fifth, the deterioration of the respiratory condition was investigated in terms of physical and clinical examinations. A heart rate less than 160 was given a score of zero, a heart rate between 160 and 180 was given a score of 1, and a heart rate greater than 180 was given a score of 2. Cardiothoracic ratio less than 0.6, 0.6 to 0.65 and more than 0.65 were determined with zero, 1 and 2 scores, respectively. The status without murmur, systolic murmur and diastolic murmur were defined with 0, 1 and 2 scores, respectively. Normal peripheral pulse score zero, brachial banding score 1, brachial and dorsalis pedis banding score 2, precordial pulse not visible and not palpable with score 0, palpable precordial pulse with score 1 and visible precordial pulse with score 2. The scores of each of the clinical criteria were added together and a score equal to or greater than 3 was considered to be associated with the incidence of hemodynamically significant PDA. Then echocardiography was performed in the examined neonates by an experienced pediatric cardiologist. The results of this research were analyzed by SPSS software. In this study, p value equal to or less than 0.05 was considered statistically significant. To determine the sensitivity and specificity of clinical factors in determining PDA requiring treatment, the ROC diagram and the area under the ROC curve were used. The results related to the sensitivity and specificity of each of the physical and clinical examinations as a factor in the diagnosis of active PDA in need of treatment were compared with echocardiography results.
Results: Based on statistical analysis and ROC curve performed in this study, the relationship between scores calculated based on Clinical criteria were demonstrated with PDA. Based on this, it can be said that by measuring clinical criteria and calculating the score can be detected PDA. Also based on the ROC curve analysis at point (score) 3, the sensitivity value is 65% and the specificity value is 95%, and at point (score) 2 the sensitivity value is 90% and the specificity value is 87%.
Conclusion: AUC = 0.94 for the diagnosis of hs-PDA indicates the fact that the definition of the score parameter based on the clinical criteria presented in this research can help in the diagnosis of PDA without echo. Only the difference between the pre-ductal and post-ductal oxygen saturation and the intensity of the dorsalis pedis pulse should be taken into account. Also, since the level of sensitivity is higher in the score of two, and this means that the false negative cases are less in the score of two, therefore, the score of two can be a more appropriate score for detecting cases that need treatment. According to the ROC curve of 5 clinical criteria for the diagnosis of hemodynamically PDA, the order of effectiveness of these 5 criteria are CTR, precordial pulse, heart murmur, heart rate and peripheral pulse respectively.
Preterm neonates refer to neonates who are born before 37 weeks from the first day of the last menstrual period (1) due to developmental delay and also weakness in the immune system, these neonates are about 40 times more than neonates with normal weight at risk of mortality (2). The ductus arteriosus is a vein that connects the pulmonary artery to the aorta. This duct is the fetal vascular connection between the pulmonary artery and the aorta artery, which diverts blood from the pulmonary bed to the systemic circulation during the fetal period (3). In the uterus, blood is shunted from the lungs due to the high pressure in the lungs. Therefore, the blood leaves the right ventricle, enters the ductus arteriosus, and from there enters the aorta (4). The ductus arteriosus contracts after birth and usually closes within 72 hours after birth. If this active contraction does not occur after birth, the ductus arteriosus will remain open. Usually, within 10 to 15 hours after birth, this contraction causes the functional closure of the ductus arteriosus, which starts from the side of the pulmonary artery and finally progresses to the end of the aorta (5). Therefore, keeping this duct open causes the oxygen-rich blood in the aorta to mix with the deoxygenated blood flowing in the pulmonary artery. Therefore, a lot of blood is transferred to the lungs, which increases the pressure on the heart, increases the blood pressure in the pulmonary veins, and also impairs the ventilation of the lungs (6). A large blood shunt from the ductus arteriosus increases pulmonary blood flow and also decreases systemic blood flow (7). Neonates with reduced systemic blood circulation are exposed to dangerous complications such as increased systolic and diastolic pressure, increased oxygen demand, pulmonary edema, tachycardia, active pericardium, heart failure, intracerebral hemorrhage, pulmonary hemorrhage, and necrotizing enterocolitis (8).
Methods: This cross-sectional study was conducted on preterm neonates with PDA and preterm neonates without PDA who were admitted to the NICU department of Akbarabadi Hospital in Tehran during 2017 and 2018. In this study, 124 preterm neonates with a gestational age of 25 to 37 weeks were included in the study. Preterm neonates with convulsions, life-threatening infections, clinical or radiographic evidence of necrotizing enterocolitis, evidence of hemorrhage, congenital neurological disorders, metabolic and genetic syndromes, pulmonary hypoplasia syndrome, congenital heart anomalies, and other fatal abnormalities. , were excluded from the study. Also, a checklist was provided in which case and demographic information related to preterm neonates was recorded. Parameters such as birth age, height and weight, gender, duration of hospitalization in NICU, duration of mechanical ventilation, history of any underlying or congenital disease (such as heart and lung disease, sepsis, other infectious diseases, diseases respiratory, history of cardiac arrest, etc.), neurological diseases, type of birth (NVD or cesarean section), gestational age, mothers' age were also recorded. After initial examinations and selection of patients based on inclusion and exclusion criteria, various clinical parameters in newborns including heart rate, peripheral pulse status, precordial pulse status, heart murmur status, cardiothoracic ratio, first minute Apgar score and Fifth, the deterioration of the respiratory condition was investigated in terms of physical and clinical examinations. A heart rate less than 160 was given a score of zero, a heart rate between 160 and 180 was given a score of 1, and a heart rate greater than 180 was given a score of 2. Cardiothoracic ratio less than 0.6, 0.6 to 0.65 and more than 0.65 were determined with zero, 1 and 2 scores, respectively. The status without murmur, systolic murmur and diastolic murmur were defined with 0, 1 and 2 scores, respectively. Normal peripheral pulse score zero, brachial banding score 1, brachial and dorsalis pedis banding score 2, precordial pulse not visible and not palpable with score 0, palpable precordial pulse with score 1 and visible precordial pulse with score 2. The scores of each of the clinical criteria were added together and a score equal to or greater than 3 was considered to be associated with the incidence of hemodynamically significant PDA. Then echocardiography was performed in the examined neonates by an experienced pediatric cardiologist. The results of this research were analyzed by SPSS software. In this study, p value equal to or less than 0.05 was considered statistically significant. To determine the sensitivity and specificity of clinical factors in determining PDA requiring treatment, the ROC diagram and the area under the ROC curve were used. The results related to the sensitivity and specificity of each of the physical and clinical examinations as a factor in the diagnosis of active PDA in need of treatment were compared with echocardiography results.
Results: Based on statistical analysis and ROC curve performed in this study, the relationship between scores calculated based on Clinical criteria were demonstrated with PDA. Based on this, it can be said that by measuring clinical criteria and calculating the score can be detected PDA. Also based on the ROC curve analysis at point (score) 3, the sensitivity value is 65% and the specificity value is 95%, and at point (score) 2 the sensitivity value is 90% and the specificity value is 87%.
Conclusion: AUC = 0.94 for the diagnosis of hs-PDA indicates the fact that the definition of the score parameter based on the clinical criteria presented in this research can help in the diagnosis of PDA without echo. Only the difference between the pre-ductal and post-ductal oxygen saturation and the intensity of the dorsalis pedis pulse should be taken into account. Also, since the level of sensitivity is higher in the score of two, and this means that the false negative cases are less in the score of two, therefore, the score of two can be a more appropriate score for detecting cases that need treatment. According to the ROC curve of 5 clinical criteria for the diagnosis of hemodynamically PDA, the order of effectiveness of these 5 criteria are CTR, precordial pulse, heart murmur, heart rate and peripheral pulse respectively.
Mahboubeh Pazoki, Ebrahim Babaei, Amirhossein Niknazar, Pegah Joghataei, Marjan Hajahmadi, Tahere Zarook,
Volume 30, Issue 7 (10-2023)
Volume 30, Issue 7 (10-2023)
Abstract
Background & Aims: Patients suffering from End-stage renal disease (ESRD), which means complete dysfunction of kidneys can experience medical disorders due to important rules of kidneys in Hemostasis and electrolyte balance. In ESRD patients, treated with conventional hemodialysis, cardiac involvement is a serious consequence and is the most important cause of death among ESRD patients. The most common cardiac involvement in these patients is heart failure ،Pericarditis and cardiomyopathy (1). Echocardiography is a powerful tool for the diagnosis and evaluation of the severity of these disorders. Structural and functional changes can be detected by Echocardiography. Left ventricular mass, Size of chambers, and size of valves are structural parameters. Left ventricular ejection fraction, Global longitudinal strain are functional parameters.
In a study performed by Liu YW, et al, they observed no significant difference in gender, age, and LVEF among groups. Compared with controls, global peak systolic longitudinal strain (GLS), circumferential strain, and strain rate were decreased in the CKD group. Along with the decline of renal function, GLS deteriorated (2).Ventricular systolic function is determined by echocardiographic findings including Ejection fraction and anatomical findings like LV mass. GLS is an echocardiographic parameter that can determine Subclinical heart failure before EF is reduced. In a study done by Krishnasamy et al, it is found that GLS is a superior predictor of heart failure and can be used instead of LVEF. This study aims to determine the effect of Different factors such as Time of hemodialysis, Diabetes, Smoking, Etiology of ESRD, and duration of CKD before ESRD on the severity of heart disease among ESRD patients at first. And we want to find if there is a significant association between LV mass and GLS.
Methods: In a cross-sectional study 55 adult patients were enrolled among all of ESRD patients who underwent hemodialysis in Hazrat-e Rasool Hospital of Tehran since September 2021 until August 2022. Complete 2-D, 3-D, M-mode, Doppler and color Doppler study were performed by a single operator for each patient and the abnormalities were recorded. Echocardiographic parameters like LV mass, LVEF, E/e , GLS were calculated. Inclusion criteria are: all the ESRD patients over 18 years old who were referred to echocardiography department for cardiac evaluation as a part of pre operation check-up. Exclusion criteria include: Low quality of Echocardiography images, obvious Arrhythmia, congenital heart disease, pericardial effusion, Infective endocarditis, and serious pulmonary or hepatic disease, Pulmonary artery hypertension (secondary to lung disease). In the beginning, 64 patients were referred but 9 patients were excluded due to having exclusion criteria. And finally, 55peoples were chosen. The procedure was explained to patients, General information like Age, Gender, weight, and height was collected by checklist, and Ethical code no IR.IUMS.REC.1402.106 was registered in Iran university of medical sciences committee of ethics. Echocardiography was performed by Philips IE33 device and X5-1 probe in 2D and 3D echocardiographic images from different views for evaluating size and function of left ventricle and the size and function of valves. Full volume image was performed in an Apical 4 chamber in 7 Beat-Breath hold cycle at first 24 hours after hemodialysis. Volumes and LVEF were calculated by Q-lab image arena software. Apical 4,2,3 chamber views were calculated for detecting left ventricular GLS by cardiac motion quantification (CMQ) method. and data were analyzed by IBM SPSS statics version 26 by 95% meaningfulness.
Results: Considering the probable effect of the Time of hemodialysis on the cardiac findings in Echocardiography we evaluate correction between the Time of hemodialysis with LV mass, GLS, and LVEF. In pearson correlate, in SPSS we found a significant relationship between time on hemodialysis and increasing LV mass/BSA (P value<0.01) and decreasing GLS and LVEF. We hypothesized that the duration of CKD before initiating Hemodialysis may be a probable factor that can affect cardiac function. Hence, we use the Pearson correlation again for evaluating the relation between the time of CKD before starting hemodialysis and LV mass, GLS, LVEF, E/e’. Strangely we found there is not a significant relationship between CKD and these parameters (P value=0.07 for LVEF, 0.197 for LV mass/BSA, 0.541 for E/e’, 0.059 for GLS). An increase in LV mass in ESRD patients can be related to several different causes like: increasing Afterload, Volume overload, and other factors. We hypothesize increase on LV mass can affect ventricular systolic dysfunction and GLS. So, we check their relation using the pearson correlation.
We exclude the effect of confounding variants like smoking, Diabetes, Hypertension, Hyperlipidemia. And We found there is a significant relation between LV mass with GLS. In other word: an increase in mass can be a cause of decreasing GLS.
Conclusion: According to the statistical studies, it seems that End-stage renal disease, which means requirement of regular dialysis, can lead to cardiac complications in terms of subclinical heart failure, increased LV mass, and decreased ventricular ejection fraction. In the next phase of investigations, increase in the duration of the disease and the progression of ESRD can be significantly related to the increase in LV mass and the decrease in GLS. We found that increase in ventricular mass can be independent of the influence of other cofounder factors. Reduce the amount of GLS. In fact, left ventricular hypertrophy can be a determining factor for patients to progress to subclinical heart failure. Therefore, based on the available findings, it can be concluded that in the early stages of hemodialysis, it is necessary to perform cardiovascular evaluations and echocardiography of patients dependent on hemodialysis and to measure criteria such as GLS and LV mass, before causing obvious ventricular failure. With the least decrease in GLS or increase in LV mass, kidney transplant should be performed.
In a study performed by Liu YW, et al, they observed no significant difference in gender, age, and LVEF among groups. Compared with controls, global peak systolic longitudinal strain (GLS), circumferential strain, and strain rate were decreased in the CKD group. Along with the decline of renal function, GLS deteriorated (2).Ventricular systolic function is determined by echocardiographic findings including Ejection fraction and anatomical findings like LV mass. GLS is an echocardiographic parameter that can determine Subclinical heart failure before EF is reduced. In a study done by Krishnasamy et al, it is found that GLS is a superior predictor of heart failure and can be used instead of LVEF. This study aims to determine the effect of Different factors such as Time of hemodialysis, Diabetes, Smoking, Etiology of ESRD, and duration of CKD before ESRD on the severity of heart disease among ESRD patients at first. And we want to find if there is a significant association between LV mass and GLS.
Methods: In a cross-sectional study 55 adult patients were enrolled among all of ESRD patients who underwent hemodialysis in Hazrat-e Rasool Hospital of Tehran since September 2021 until August 2022. Complete 2-D, 3-D, M-mode, Doppler and color Doppler study were performed by a single operator for each patient and the abnormalities were recorded. Echocardiographic parameters like LV mass, LVEF, E/e , GLS were calculated. Inclusion criteria are: all the ESRD patients over 18 years old who were referred to echocardiography department for cardiac evaluation as a part of pre operation check-up. Exclusion criteria include: Low quality of Echocardiography images, obvious Arrhythmia, congenital heart disease, pericardial effusion, Infective endocarditis, and serious pulmonary or hepatic disease, Pulmonary artery hypertension (secondary to lung disease). In the beginning, 64 patients were referred but 9 patients were excluded due to having exclusion criteria. And finally, 55peoples were chosen. The procedure was explained to patients, General information like Age, Gender, weight, and height was collected by checklist, and Ethical code no IR.IUMS.REC.1402.106 was registered in Iran university of medical sciences committee of ethics. Echocardiography was performed by Philips IE33 device and X5-1 probe in 2D and 3D echocardiographic images from different views for evaluating size and function of left ventricle and the size and function of valves. Full volume image was performed in an Apical 4 chamber in 7 Beat-Breath hold cycle at first 24 hours after hemodialysis. Volumes and LVEF were calculated by Q-lab image arena software. Apical 4,2,3 chamber views were calculated for detecting left ventricular GLS by cardiac motion quantification (CMQ) method. and data were analyzed by IBM SPSS statics version 26 by 95% meaningfulness.
Results: Considering the probable effect of the Time of hemodialysis on the cardiac findings in Echocardiography we evaluate correction between the Time of hemodialysis with LV mass, GLS, and LVEF. In pearson correlate, in SPSS we found a significant relationship between time on hemodialysis and increasing LV mass/BSA (P value<0.01) and decreasing GLS and LVEF. We hypothesized that the duration of CKD before initiating Hemodialysis may be a probable factor that can affect cardiac function. Hence, we use the Pearson correlation again for evaluating the relation between the time of CKD before starting hemodialysis and LV mass, GLS, LVEF, E/e’. Strangely we found there is not a significant relationship between CKD and these parameters (P value=0.07 for LVEF, 0.197 for LV mass/BSA, 0.541 for E/e’, 0.059 for GLS). An increase in LV mass in ESRD patients can be related to several different causes like: increasing Afterload, Volume overload, and other factors. We hypothesize increase on LV mass can affect ventricular systolic dysfunction and GLS. So, we check their relation using the pearson correlation.
We exclude the effect of confounding variants like smoking, Diabetes, Hypertension, Hyperlipidemia. And We found there is a significant relation between LV mass with GLS. In other word: an increase in mass can be a cause of decreasing GLS.
Conclusion: According to the statistical studies, it seems that End-stage renal disease, which means requirement of regular dialysis, can lead to cardiac complications in terms of subclinical heart failure, increased LV mass, and decreased ventricular ejection fraction. In the next phase of investigations, increase in the duration of the disease and the progression of ESRD can be significantly related to the increase in LV mass and the decrease in GLS. We found that increase in ventricular mass can be independent of the influence of other cofounder factors. Reduce the amount of GLS. In fact, left ventricular hypertrophy can be a determining factor for patients to progress to subclinical heart failure. Therefore, based on the available findings, it can be concluded that in the early stages of hemodialysis, it is necessary to perform cardiovascular evaluations and echocardiography of patients dependent on hemodialysis and to measure criteria such as GLS and LV mass, before causing obvious ventricular failure. With the least decrease in GLS or increase in LV mass, kidney transplant should be performed.
Roya Isa Tafreshi, Mohammad Radgoodarzi, Maryam Hassani, Mohammad Ali Navabi Shirazi,
Volume 31, Issue 1 (3-2024)
Volume 31, Issue 1 (3-2024)
Abstract
Background & Aims: Tetralogy of Fallot (TF) represents the most prevalent form of cyanotic congenital heart disease, characterized by chronic pulmonary regurgitation, the foremost postoperative complication leading to right ventricular (RV) dilation, progressive RV dysfunction, and life-threatening arrhythmia (2). Multiple criteria have been established to determine the optimal timing for surgical intervention in asymptomatic patients for this progressive condition. Nevertheless, achieving consensus on the optimal timing of pulmonary valve replacement (PVR) remains elusive (2, 11). An essential criterion for this decision is the assessment of RV systolic function, which proves challenging due to the complex RV geometry and the absence of standardized methods for RV volume assessment. Consequently, the limitations of echocardiography have prompted the use of cardiac MRI (CMR) as an essential tool for RV size and function assessment (6, 10). However, the limited availability and accessibility of CMR compared to echocardiography highlight the need for reliable and reproducible echocardiographic methods to determine the appropriate timing for CMR assessment (8, 9, 50).
The objective of our study was to identify optimal echocardiographic parameters for RV function and size that would indicate the necessity for further CMR evaluation. Additionally, we aimed to investigate potential correlations between echocardiographic measures of RV systolic function and CMR-derived parameters.
Methods: This is a prospective study of patients with repaired TF who revealed severe pulmonary regurgitation or severe RV dilation and who underwent cardiac MRI between 2015 and 2022. A trained physician, blinded to CMR data, conducted the transthoracic echocardiographic study within six months before the CMR evaluation. Inclusion criteria were: (1) age below 18 years, (2) significant RV dilation, (3) absence of significant residual cardiac lesions or arrhythmias, (4) left ventricular ejection fraction (LVEF) greater than 50%, (5) no limitations in daily physical activities (NYHA functional class I), and (6) absence of concomitant diseases.
All patients exhibited regular sinus rhythm with complete right bundle branch block. The study protocol followed the guidelines of the Declaration of Helsinki for humans and was approved by our institutional review board.
Echocardiographic data were obtained and analyzed according to the guidelines of the American Society of Echocardiography (14, 15, 26). To measure ventricle size in the four-chamber view, the largest transverse diameter of the right ventricle in the basal third was recorded and expressed in millimeters, then compared with the data obtained in MRI.
Quantitative RV function was assessed by calculating fractional area change (FAC) and right ventricular outflow tract fractional shortening (RVOT-FS) using 2D echocardiography. FAC, considered one of the best-validated quantitative methods for measuring RV function, with a value of less than 35%, is considered indicative of ventricular dysfunction(16, 20). Tricuspid annular plane systolic excursion (TAPSE) of the lateral tricuspid annulus, a reproducible marker of RV systolic function, was measured using 2D-guided M-mode from the apical 4-chamber view. Previous reports have shown that TAPSE less than 16 mm is correlated with RV systolic dysfunction(21). The longitudinal performance of the RV was evaluated using Tissue Doppler Imaging (TDI) by measuring parameters at the lateral corner of the tricuspid valve annulus. The peak longitudinal systolic velocity of the RV free wall (s') was obtained as an index of regional RV systolic function, with values less than 9.5 cm/s considered indicative of right ventricular dysfunction(26). Additionally, myocardial acceleration during isovolumic contraction (IVA) as a measure of ventricular contractility was calculated from the basal level of the RV-free wall. Also, the TDI-derived myocardial performance index (TDI-MPI) was determined from the lateral ring of the tricuspid valve(22).
Results: The study included 37 patients with an average age of 10.8 ± 2.2 (range:7-17) years who underwent TF repair at an average age of 13.8 ± 5.5 months. All patients received a trans annular patch enlargement of the right ventricular outflow tract, with a median follow-up post-operation of 9.5 ± 2.1 years. All patients exhibited LVEF within the normal range, and none had RVEF less than 40% by CMR. We observed a significant correlation between echocardiographic-derived RV end-diastolic diameter and RV end-diastolic volume obtained by CMR (r=0.61, p< 0.05). RV-FAC<35% was not seen in any of the patients and the values of RV-FAC were correlated with CMR-derived RVEF (P<0.01, r =0.58). Furthermore, RVOT-FS, as one of the new measures of RV systolic function, showed a direct statistical relationship with CMR-RVEF (P< 0.02, r=0.57) (20). Although TAPSE values were lower than those reported in the normal population, there was no statistical correlation with CMR-RVEF or right ventricular volumes (9, 37). MPI was calculated as an important measure of global RV function with an average value of 0.48±0.08, but no significant correlation was found with CMR-RVEF. IVA values, as another measure of longitudinal function of the right ventricle, were found within the normal range, but the statistical relationship between this measure and CMR-RVEF was not seen (29, 47). The average s´ wave velocity was 7.2± 1.4 cm/s, lower than the normal population in previous reports, but had no statistical relationship with CMR-RVEF (26). On the other hand, our findings revealed a significant correlation between s´ velocity, and IVA values with ventricular diastolic volume, which is consistent with previous studies (30, 39).
Conclusion: Measuring both RVOT-FS and RV-FAC indices by echocardiography is crucial in predicting CMR-RVEF, serving as one of the most important standard criteria in deciding the appropriate timing for PVR. Simultaneously, monitoring the increase of right ventricular diameter with echocardiography offers an easy and accurate method to estimate the severity of ventricular dilatation. IVA and s' wave, as indicators of regional right ventricular myocardial function, along with MPI as an index of global ventricular function, correlated with the degree of ventricular dilatation caused by increased volume load and will play a role in the follow-up process of patients with repaired TF. Therefore, measuring this set of echocardiographic indices is important in estimating both CMR-derived RVEF and RV diastolic volume, significantly contributing to reducing the frequency of MRI in the follow-up of patients with repaired TF.
The objective of our study was to identify optimal echocardiographic parameters for RV function and size that would indicate the necessity for further CMR evaluation. Additionally, we aimed to investigate potential correlations between echocardiographic measures of RV systolic function and CMR-derived parameters.
Methods: This is a prospective study of patients with repaired TF who revealed severe pulmonary regurgitation or severe RV dilation and who underwent cardiac MRI between 2015 and 2022. A trained physician, blinded to CMR data, conducted the transthoracic echocardiographic study within six months before the CMR evaluation. Inclusion criteria were: (1) age below 18 years, (2) significant RV dilation, (3) absence of significant residual cardiac lesions or arrhythmias, (4) left ventricular ejection fraction (LVEF) greater than 50%, (5) no limitations in daily physical activities (NYHA functional class I), and (6) absence of concomitant diseases.
All patients exhibited regular sinus rhythm with complete right bundle branch block. The study protocol followed the guidelines of the Declaration of Helsinki for humans and was approved by our institutional review board.
Echocardiographic data were obtained and analyzed according to the guidelines of the American Society of Echocardiography (14, 15, 26). To measure ventricle size in the four-chamber view, the largest transverse diameter of the right ventricle in the basal third was recorded and expressed in millimeters, then compared with the data obtained in MRI.
Quantitative RV function was assessed by calculating fractional area change (FAC) and right ventricular outflow tract fractional shortening (RVOT-FS) using 2D echocardiography. FAC, considered one of the best-validated quantitative methods for measuring RV function, with a value of less than 35%, is considered indicative of ventricular dysfunction(16, 20). Tricuspid annular plane systolic excursion (TAPSE) of the lateral tricuspid annulus, a reproducible marker of RV systolic function, was measured using 2D-guided M-mode from the apical 4-chamber view. Previous reports have shown that TAPSE less than 16 mm is correlated with RV systolic dysfunction(21). The longitudinal performance of the RV was evaluated using Tissue Doppler Imaging (TDI) by measuring parameters at the lateral corner of the tricuspid valve annulus. The peak longitudinal systolic velocity of the RV free wall (s') was obtained as an index of regional RV systolic function, with values less than 9.5 cm/s considered indicative of right ventricular dysfunction(26). Additionally, myocardial acceleration during isovolumic contraction (IVA) as a measure of ventricular contractility was calculated from the basal level of the RV-free wall. Also, the TDI-derived myocardial performance index (TDI-MPI) was determined from the lateral ring of the tricuspid valve(22).
Results: The study included 37 patients with an average age of 10.8 ± 2.2 (range:7-17) years who underwent TF repair at an average age of 13.8 ± 5.5 months. All patients received a trans annular patch enlargement of the right ventricular outflow tract, with a median follow-up post-operation of 9.5 ± 2.1 years. All patients exhibited LVEF within the normal range, and none had RVEF less than 40% by CMR. We observed a significant correlation between echocardiographic-derived RV end-diastolic diameter and RV end-diastolic volume obtained by CMR (r=0.61, p< 0.05). RV-FAC<35% was not seen in any of the patients and the values of RV-FAC were correlated with CMR-derived RVEF (P<0.01, r =0.58). Furthermore, RVOT-FS, as one of the new measures of RV systolic function, showed a direct statistical relationship with CMR-RVEF (P< 0.02, r=0.57) (20). Although TAPSE values were lower than those reported in the normal population, there was no statistical correlation with CMR-RVEF or right ventricular volumes (9, 37). MPI was calculated as an important measure of global RV function with an average value of 0.48±0.08, but no significant correlation was found with CMR-RVEF. IVA values, as another measure of longitudinal function of the right ventricle, were found within the normal range, but the statistical relationship between this measure and CMR-RVEF was not seen (29, 47). The average s´ wave velocity was 7.2± 1.4 cm/s, lower than the normal population in previous reports, but had no statistical relationship with CMR-RVEF (26). On the other hand, our findings revealed a significant correlation between s´ velocity, and IVA values with ventricular diastolic volume, which is consistent with previous studies (30, 39).
Conclusion: Measuring both RVOT-FS and RV-FAC indices by echocardiography is crucial in predicting CMR-RVEF, serving as one of the most important standard criteria in deciding the appropriate timing for PVR. Simultaneously, monitoring the increase of right ventricular diameter with echocardiography offers an easy and accurate method to estimate the severity of ventricular dilatation. IVA and s' wave, as indicators of regional right ventricular myocardial function, along with MPI as an index of global ventricular function, correlated with the degree of ventricular dilatation caused by increased volume load and will play a role in the follow-up process of patients with repaired TF. Therefore, measuring this set of echocardiographic indices is important in estimating both CMR-derived RVEF and RV diastolic volume, significantly contributing to reducing the frequency of MRI in the follow-up of patients with repaired TF.
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