Abstract 12799: Left Ventricular End-Diastolic Pressure Correlates with Right Ventricular End-Diastolic Volume in Patients Following Tetralogy of Fallot Repair
Introduction: Right ventricular dilation is a long-term complication after tetralogy of Fallot (TOF) repair and is associated with poor outcomes. Left ventricular end-diastolic pressure (LVEDP) ≥12 mmHg has been shown to be a risk factor for ventricular arrhythmias. The cause of elevated LVEDP is not known and the relationship of LVEDP to right ventricular performance has never been examined.
Hypothesis: We hypothesized that as a result of ventricular-ventricular interactions, right ventricular dilation leads to left ventricular dysfunction and an increase in LVEDP in patients following TOF repair.
Methods: A retrospective review was performed of consecutive patients with repaired TOF who underwent cardiac catheterization within 6 months of cardiac MRI at a single institution from 1/1/03 to 4/1/10. For each patient, LVEDP was recorded from the catheterization and indexed right ventricular end-diastolic volume (RVEDV) recorded from the MRI. Other catheterization and MRI-derived variables were recorded and clinical histories were reviewed.
Results: Thirty-three patients met inclusion criteria with a median age of 11.6 (range 0.6-54.7) years and a median time between surgical repair and catheterization of 10.9 (range 0.3-40.9) years. Compared to patients with LVEDP <12 mmHg, those with LVEDP ≥12 mmHg had a significantly higher mean RVEDV (145.6 ± 47.7 ml vs. 101.3 ± 33.7 ml, p=0.006) and mean right ventricular end-diastolic pressure (RVEDP) (11.4 ± 1.3 mmHg vs. 8.4 ± 3.3 mmHg, p=0.006). Further, those patients with LVEDP ≥12 mmHg had a significantly higher systolic (35.4 ± 8.7 mmHg vs. 25.6 ± 7.7 mmHg, p=0.003) and mean (18.7 ± 4.1 mmHg vs. 15.5 ± 3.8 mmHg, p=0.04) pulmonary artery pressure compared to those with LVEDP <12 mmHg. There were no significant correlations identified between LVEDP and a variety of other potential demographic, clinical, catheter- and MRI-derived predictor variables.
Conclusions: In this retrospective review of patients after TOF repair, elevation of LVEDP ≥12 mmHg was associated with significantly higher mean RVEDV and RVEDP compared with normal LVEDP. Future prospective studies with longitudinal follow-up are required to demonstrate a causal link between right ventricular dilation and left ventricular diastolic dysfunction.
- © 2010 by American Heart Association, Inc.