法洛氏四重症是一種常見發紺性的先天心臟結構缺陷的結果。動能在泵血過程中起著重要的作用，它是涉及血液流動過程的一個量度。在這項研究中，我們的目的是在保留心臟功能的條件下研究早期法洛氏四重症患者左心室和右心室的心肌和心室內動能以及肺動脈動能之間的相互作用。
實驗群體為49名法洛氏四重症患者和47名年齡匹配的正常對照組。採用組織相位圖和四維血流分析技術評估左心室和右心室的心肌和血流速度從而得到相應的動能。
我们觀察到法洛氏四重症患者在基底，中部和心尖切片顯示左心室和右心室速度减慢。至於徑向周向縱向的動能，法洛氏四重症患者左心室的徑向動能較高，右心室的縱向動能較低。此外，在基底、中部和心尖的動能中，法洛氏四重症組的基底動能較低，心尖動能較高。在右心室舒張期，患者的心室内的血流動能高於正常對照组。法洛氏四重症組在收縮期和舒張期的肺動脈動能均高於正常組。法洛氏四重症患者心肌動能與心室内動能缺乏正相關，反映了心肌和心室內血流紊亂。此外，法洛氏四重症患者心肌動能與肺動脈動能無顯著相關性，證實肺動脈逆流可能影響心肌纖維。結果表明，無論是正常對照組還是法洛氏四重症組，左心室和心右室的心肌動能與肺動脈逆流均無顯著相關性，證實動能和肺動脈逆流是相互獨立的，接受者操作特性曲線和多元回歸分析表明心肌動能，心室內動能和肺動脈動能是評估心臟容量數據的重要指標。
綜上所述，從能量轉換的角度來看，動能值的異常和動能分佈的改變可為左心室功能保留的法洛氏四重症患者提供有用的資訊。

Repaired Tetralogy of Fallot (rTOF) is the result of structural defects in the heart, which is the common form of cyanotic congenital heart. The kinetic energy (KE) plays an important role in pumping blood, which is a measure of the amount of work involved directly in moving blood. In this study, we aimed to investigate the interaction between myocardial and intraventricular KE in both left ventricular (LV) and right ventricular (RV) and pulmonary artery KE for rTOF patients in an early stage with preserved cardiac function.
We recruited 49 rTOF patients and 47 age-matched normal controls. Tissue phase mapping and 4D flow MRI was performed for evaluating LV and RV myocardial and flow velocities and the corresponding KE.
rTOF patients revealed reduced velocity of LV and RV in the basal, mid, and apical slices. As for KErøz, rTOF patients displayed higher KEr in LV and lower KEz in RV. Furthemore, rTOF group presented lower %KEBase and higher %KEApex in KEBMA. KE of intraventricular flow revealed higher between rTOF patients and normal controls in RV diastole. The rTOF group was with a higher KEPA than normal group during both systolic and diastolic periods. The observation of absence positive correlation between KEmyo and KEven in rTOF patients reflected the disordered incoherence of myocardium and intraventricular flow. Moreover, rTOF patients were no significant correlation between KEmyo and KEPA imply that regurgitant flow may impact myocardial fiber. Patients demonstrated that the correlation between myocardial KE and pulmonary regurgitation (PR) were no significant correlation in LV and RV whether in normal controls or rTOF patients, suggesting the KE is independent of PR. ROC and multiple regression illustrated myocardial KE, intraventricular KE and pulmonary artery KE are important indicators to evaluate the cardiac volume data.
In conclusion, from an insight of energy conversion, the abnormal KE values and altered distribution of KE may provide useful information for rTOF patients with preserved LV cardiac function.

Chapter 1 Introduction 1
1.1 Tetralogy of Fallot 1
1.1.1 Pathophysiology 1
1.1.2 Experimental animal models 3
1.2 Diagnosis of TOF 4
1.2.1 Electrophysiological 4
1.2.2 Echocardiography 5
1.2.3 Cardiac Magnetic Resonance Imaging 6
1.3 Kinetic Energy 7
1.3.1 Effect of Kinetic Energy 7
1.3.2 Intraventricular Kinetic Energy 7
1.4 Motivation 8
1.5 Dissertation Orientation 9
Chapter 2 Theory 10
2.1 Phase-Contrast MRI 10
2.2 4D Flow MRI 11
2.3 Tissue Phase Mapping 12
Chapter 3 Materials and Methods 13
3.1 Study cohort 13
3.2 MRI Acquisition 15
3.2.1 Cine Short-Axis View 15
3.2.2 4D Flow MRI 16
3.2.3 Tissue Phase Mapping 17
3.3 Data Analysis: Cardiopulmonary Index 18
3.4 Data Analysis: Myocardial Motion 20
3.5 Data Analysis: Kinetic Energy 21
3.5.1 Myocardial Kinetic Energy 21
3.5.2 Intraventricular Kinetic Energy 22
3.5.3 Pulmonary Artery Kinetic Energy 23
3.5.4 KE index 24
3.6 Statistical Analysis 25
Chapter 4 Results: KE 26
4.1 Demographic characteristics 26
4.2 Myocardial Motion 32
4.2.1 Time Course of Myocardial Motion 32
4.2.2 Myocardial Velocity 34
4.2.3 Myocardial Time to Peak 37
4.2.4 Myocardial Twist 40
4.3 Myocardial KE 42
4.3.1 Time Course of Myocardial KE 42
4.3.2 Myocardial KErøz 44
4.3.3 Myocardial KEBMA 50
4.3.4 Myocardial KErøz in KEBMA 55
4.3.5 Myocardial KEBMA in KErøz 61
4.4 Intraventricular KE 67
4.4.1 Intraventricular KE 67
4.4.2 Interaction of Intraventricular KE and Myocardial KE 68
4.5 Pulmonary Artery KE 71
4.5.1 Pulmonary Artery Velocity 71
4.5.2 Pulmonary Artery KE 72
Chapter 5 Results: Correlation 73
5.1 Correlation 73
5.1.1 Correlation Analysis: Myocardial KE and Intraventricular KE 73
5.1.2 Correlation Analysis: Myocardial KE and Pulmonary Artery KE 78
5.1.3 Correlation Analysis: Intraventricular KE and Pulmonary Artery KE 83
5.1.4 Correlation Analysis: Myocardial KE and Volumetric Data 85
5.1.5 Correlation Analysis: Intraventricular KE and volumetric Data 92
5.1.6 Correlation Analysis: Pulmonary Artery KE and volumetric Data 95
5.1.7 Correlation Analysis: KE and Catheter Pressure, BNP, Peak VO2 97
5.2 ROC Curve and Multiple Regression and Collinearity Statistics 101
5.2.1 ROC Curve 101
5.2.2 Backward Elimination Procedure Process for Multiple Regression and Collinearity Statistics 108
Chapter 6 Discussion 118
6.1 Major Findings 118
6.2 KE and %KE 120
6.2.1 Myocardial KErøz 120
6.2.2 Myocardial KEBMA 122
6.2.3 Myocardial KErøz in KEBMA 123
6.2.4 Myocardial KEBMA in KErøz 124
6.3 Interaction of Myocardial, Intraventricular and Pulmonary Artery KE 125
6.4 Interaction of Kinetic Energy and Cardiac Volumetric Indices 127
6.5 Interaction of Kinetic Energy and Catheter Pressure 129
6.6 ROC Curve and Multiple Regression and Collinearity Statistics 130
6.7 Limitation 132
Chapter 7 Conclusion 134
7.1 Conclusion 134
7.2 Future Work 135
Chapter 8 References 136
Chapter 9 Appendix 143
AppendixⅠ: Abbreviation List and definition List of Quantitative Indices 143
AppendixⅡ: Response to defense committee members 145
AppendixⅢ: Turnitin 148

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