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Detection of left ventricular asynchrony in patients with right bundle branch block after repair of tetralogy of Fallot using tissue-Doppler imaging-derived strain

Mohamed Y. Abd El Rahman, MD^*, Wei Hui, MD^*, Moustafa Yigitbasi, MD^*, Fatima Dsebissowa, MD^*, Stephan Schubert, MD^*, Roland Hetzer, MD, PhD, Peter E. Lange, MD, PhD^* and Hashim Abdul-Khaliq, MD, PhD^*,*

^* Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany

View larger version (13K): [in a new window]   Figure 1 Comparison of the left ventricular delay between patients after tetralogy of Fallot (TOF) repair and healthy control subjects. Compared with control subjects, patients after TOF repair have significant left ventricular delay. *TOF versus normal healthy subjects, p < 0.05.

View larger version (16K): [in a new window]   Figure 2 Comparison of the left ventricular delay between patients after tetralogy of Fallot (TOF) repair in New York Heart Association (NYHA) functional class I and those in class II. Patients in NYHA functional class II have significantly more left ventricular delay when compared with patients in class I. *TOF versus normal healthy subjects, p < 0.05.

View larger version (19K): [in a new window]   Figure 3 Tetralogy of Fallot (TOF) patients with and without left ventricular asynchrony. According to the mean left ventricular delay among the normal subjects, a normal range (mean ± 2 SD) was plotted. Using this normal range, TOF patients were further divided into two groups: group 1, TOF patients without left ventricular asynchrony (n = 12, 48%) and group 2, TOF patients with left ventricular asynchrony (n = 13, 52%). Solid circles = patients after TOF repair; open triangles = healthy control subjects.

View larger version (16K): [in a new window]   Figure 4 Comparison of global left ventricular (LV) function assessed by the Tei index between patients after tetralogy of Fallot (TOF) repair with and without LV asynchrony. *Patients after TOF repair without left intraventricular asynchrony and those with left ventricular asynchrony, p < 0.05.

View larger version (18K): [in a new window]   Figure 5 Receiver-operating characteristic (ROC) curve of the QRS duration for prediction of left ventricular (LV) asynchrony in patients after tetralogy of Fallot (TOF) repair and right bundle branch block. AUC = area under the curve.