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Right ventricular outflow tract premature ventricular contractions and right ventricular function assessed by two-dimensional speckle tracking echocardiography
Session:
Painel 3 - Imagiologia Cardiovascular 3
Speaker:
Marta Sofia Ferreira Fonseca
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Marta Ferreira Fonseca; Leonor Parreira; José Maria Farinha; Rita Marinheiro; Ana Fátima Esteves; Sara Gonçalves; Rui Caria
Abstract
<p><strong>Introduction:</strong> Premature ventricular contractions (PVCs) originating in the right ventricular outflow tract (RVOT) are considered idiopathic and benign and echocardiographic conventional measurements are typically normal. However, from an electroanatomical mapping perspective, it has recently been demonstrated that patients with PVCs from the RVOT and apparently normal hearts have areas of low voltage electrograms in the RVOT. It is then reasonable to question if in RVOT PVCs patients, along with an apparent electrical remodeling process there is also an anatomical substrate behind the PVCs.</p> <p><strong>Purpose:</strong> To assess whether right ventricle global longitudinal strain (RV-GLS), determined by two-dimensional speckle tracking echocardiography, differ between RVOT PVCs patients and healthy controls.</p> <p><strong>Methods:</strong> We retrospectively selected consecutive patients with PVCs from the RVOT that underwent electrophysiological study and catheter ablation between 2016 and 2019. Patients with documented structural heart disease were excluded. Transthoracic echocardiography was performed after the ablation procedure and RV-GLS was determined (Figure 1), as well as left ventricle global longitudinal strain (LV-GLS) and conventional ultrasound measurements of RV and LV function.</p> <p><strong>Results:</strong> We studied 21 patients with RVOT PVCs and 13 controls (baseline characteristics are summarized in Table I). Median PVCs burden in the RVOT PVCs group prior to ablation was 16197 (Interquartile range: 13613) PVCs in 24-hour holter monitoring. The acute success rate of the catheter ablation procedure, defined as absence of RVOT PVCs for at least 30 minutes after the procedure, was 86% (n=18). Patients with PVCs from the RVOT had lower values of RV-GLS compared with the control group (-19% versus -22%, p=0.041). They also had lower values of LV-GLS compared with the control group, although still within the range of normal values (-19% versus -21%, p=0.018). Regarding RVOT PVCs patients only, RV-GLS and LV-GLS did not differ between the patients in which the catheter ablation procedure was successful and those in which it was not (-21% versus -19%, p=0.223 and -19% versus -19%, p=0.791, respectively). We also observed that the burden of PVCs prior to the catheter ablation procedure had no correlation with the RV-GLS and LV-GLS values obtained (r=-0.046, p=0.866 and r=-0.165, p=0.528, respectively). RV-GLS also had a positive correlation with RVOT proximal diameter (r=0.487, p=0.025).</p> <p><strong>Conclusion:</strong> In this group of RVOT PVCs patients, we found worse RV-GLS values (and therefore sub-clinical myocardial dysfunction) when compared to healthy controls, irrespective of previous PVCs burden and success of the catheter ablation procedure.</p>
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