Right Ventricular Function with Standard and Speckle-Tracking Echocardiography and Clinical Events in Adults with D-Transposition of the Great Arteries Post Atrial Switch

Background: The prognostic value of deformation parameters of the systemic right ventricle in adults with D-transposition of the great arteries and prior atrial switch has not been reported. Methods: Sixty-four adults with D-transposition of the great arteries and prior atrial switch (mean age, 29 +/- 6 years; 22 women; mean right ventricular [RV] fractional area change, 22.9 +/- 7.5%; 31 with pacemakers at baseline) and no histories of heart failure or ventricular tachycardia were prospectively evaluated. Global longitudinal strain (GS), global systolic strain rate (GSRs), and global early diastolic strain rate (GSRe) of the right ventricle were measured using speckle tracking from apical views and compared with standard parameters of RV function (fractional area change, tricuspid annular plane systolic excursion, tissue Doppler velocities, and isovolumic acceleration) for association with and potential prediction of clinical events, defined as incident stage C heart failure or ventricular tachycardia. Results: Baseline RV GS, GSRs, and GSRe were -12.5 +/- 3.0%, -0.59 +/- 0.14 sec(-1), and 0.68 +/- 0.22 sec(-1), respectively. After a median of 2.4 years (interquartile range, 1.5-4.1 years), 12 patients (19%) presented with clinical events (heart failure in 11 patients, ventricular tachycardia in one patient). In Cox models, RV GS had the strongest association with clinical events (hazard ratio [HR] per 1%, 1.35; 95% confidence interval [CI], 1.14-1.58; P < .001), followed by GSRs (HR per 0.01 sec(-1), 1.06; 95% CI, 1.02-1.11; P = .006), GSRe (HR per -0.01 sec(-1), 1.04; 95% CI, 1.00-1.07; P = .031), and fractional area change (HR per -1%, 1.08; 95% CI, 1.00-1.17; P = .047). Other measures of RV function were not significantly associated with risk for events. In receiver operating characteristic analysis, RV GS >= -10% optimally predicted future events (C = 0.83; 95% CI, 0.71-0.91; P < .001). Conclusions: Reduced longitudinal GS of the systemic right ventricle is associated with increased risk for clinical events among patients with D-transposition of the great arteries and prior atrial switch. (J Am Soc Echocardiogr 2012;25:304-12.)