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Echocardiographic predictors of elevated left ventricular end diastolic pressure in adolescent and adult patients with repaired tetralogy of Fallot

  • Adam M. Lubert (a1), Timothy B. Cotts (a2), Jeffrey D. Zampi (a2), Sunkyung Yu (a2) and Mark D. Norris (a2)...

Abstract

Elevated left ventricular end diastolic pressure is a risk factor for ventricular arrhythmias in patients with tetralogy of Fallot. The objective of this retrospective study was to identify echocardiographic measures associated with left ventricular end diastolic pressure >12 mmHg in this population. Repaired tetralogy of Fallot patients age ≥13 years, who underwent a left heart catheterisation within 7 days of having an echocardiogram were evaluated. Univariate comparison was made in echocardiographic and clinical variables between patients with left ventricular end diastolic pressure >12 versus ≤12 mmHg. Ninety-four patients (54% male) with a median age of 24.6 years were included. Thirty-four (36%) had left ventricular end diastolic pressure >12 mmHg. Patients with left ventricular end diastolic pressure >12mmHg were older (median 32.9 versus 24.0 years, p = 0.02), more likely to have a history of an aortopulmonary shunt (62% versus 38%, p = 0.03), and have a diagnosis of hypertension (24% versus 7%, p = 0.03) compared to those with left ventricular end diastolic pressure ≤12 mmHg. There were no significant differences in mitral valve E/A ratio, annular e’ velocity, or E/e’ ratio between patients with left ventricular end diastolic pressure >12 versus ≤12 mmHg. Patients with left ventricular end diastolic pressure >12mmHg had larger left atrial area (mean 17.7 versus 14.0 cm2, p = 0.03) and larger left atrium anterior–posterior diameter (mean 36.0 versus 30.6 mm, p = 0.004). In conclusion, typical echocardiographic measures of left ventricular diastolic dysfunction may not be reliable in tetralogy of Fallot patients. Prospective studies with the use of novel echocardiographic measures are needed.

Copyright

Corresponding author

Address for correspondence: Adam M. Lubert, The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA. Tel: 513-803-2243; Fax: 513-803-0079; E-mail: Adam.Lubert@cchmc.org

References

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1.Gatzoulis, MA, Balaji, S, Webber, SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975981.10.1016/S0140-6736(00)02714-8
2.Nollert, G, Fischlein, T, Bouterwek, S, et al. Long-term results of total repair of tetralogy of Fallot in adulthood: 35 years follow-up in 104 patients corrected at the age of 18 or older. Thorac Cardiovasc Surg 1997; 45: 178181.10.1055/s-2007-1013719
3.Khairy, P, Harris, L, Landzberg, MJ, et al. Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation 2008; 117: 363370.10.1161/CIRCULATIONAHA.107.726372
4.Ternestedt, BM, Wall, K, Oddsson, H, Riesenfeld, T, Groth, I, Schollin, J. Quality of life 20 and 30 years after surgery in patients operated on for tetralogy of Fallot and for atrial septal defect. Pediatr Cardiol 2001; 22: 128132.10.1007/s002460010178
5.Daliento, L, Mapelli, D, Russo, G, et al. Health related quality of life in adults with repaired tetralogy of Fallot: psychosocial and cognitive outcomes. Heart 2005; 91: 213218.10.1136/hrt.2003.029280
6.Lu, JC, Cotts, TB, Agarwal, PP, Attili, AK, Dorfman, AL. Relation of right ventricular dilation, age of repair, and restrictive right ventricular physiology with patient-reported quality of life in adolescents and adults with repaired tetralogy of Fallot. Am J Cardiol 2010; 106: 17981802.10.1016/j.amjcard.2010.08.021
7.Khairy, P, Aboulhosn, J, Gurvitz, MZ, et al. Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation 2010; 122: 868875.10.1161/CIRCULATIONAHA.109.928481
8.Nagueh, SF, Smiseth, OA, Appleton, CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17: 13211360.10.1093/ehjci/jew082
9.Nagueh, SF, Smiseth, OA, Appleton, CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29: 277314.10.1016/j.echo.2016.01.011
10.Aboulhosn, JA, Lluri, G, Gurvitz, MZ, et al. Left and right ventricular diastolic function in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Can J Cardiol 2013; 29: 866872.10.1016/j.cjca.2012.11.003
11.Vasan, RS, Benjamin, EJ, Levy, D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995; 26: 15651574.10.1016/0735-1097(95)00381-9
12.Carminati, M, Pluchinotta, FR, Piazza, L, et al. Echocardiographic assessment after surgical repair of tetralogy of fallot. Frontiers in pediatrics 2015; 3: 3.10.3389/fped.2015.00003
13.Swamy, P, Bharadwaj, A, Varadarajan, P, Pai, RG. Echocardiographic evaluation of tetralogy of Fallot. Echocardiography 2015; 2: S148S156.10.1111/echo.12437
14.Baggen, VJM, Schut, AW, Cuypers, J, et al. Prognostic value of left atrial size and function in adults with tetralogy of Fallot. Int J Cardiol 2017; 236: 125131.10.1016/j.ijcard.2017.02.153
15.Friedberg, MK, Fernandes, FP, Roche, SL, et al. Impaired right and left ventricular diastolic myocardial mechanics and filling in asymptomatic children and adolescents after repair of tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 2012; 13: 905913.10.1093/ehjci/jes067
16.Ahmad, N, Kantor, PF, Grosse-Wortmann, L, et al. Influence of RV restrictive physiology on LV diastolic function in children after tetralogy of Fallot repair. J Am Soc Echocardiogr 2012; 25: 866873.10.1016/j.echo.2012.05.011

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