Abstract 19349: Repaired Tetralogy of Fallot: End- Diastolic Pulmonary Artery Forward Flow Differences Defined by Multimodality Imaging
Background: The presence of pulmonary arterial end-diastolic forward flow (EDFF) in patients with repaired tetralogy of Fallot (TOF) is thought to indicate a non-compliant right ventricle. The purpose of our study was to investigate the associations of EDFF with echocardiogram (Echo) and cardiovascular magnetic resonance (CMR) indices of right and left heart function.
Hypothesis: EDFF is associated with reduced pulmonary regurgitation (PR) and right ventricular (RV) size.
Methods: We retrospectively analyzed 399 patients with repaired TOF who had Echo and CMR within 1 year of each other. EDFF was defined as the presence of forward flow on the main pulmonary artery or right ventricle-to-pulmonary artery conduit pulsed-wave Doppler Echo trace immediately following atrial contraction in at least 3 consecutive cardiac cycles. CMR measurements included comprehensive volumetric and flow indices of the right and left heart. Variables were summarized by presence or absence of EDFF, and differences compared. Logistic regression was used to assess the univariate associations. Multivariable associations with EDFF were investigated and a forward-selection model building procedure was implemented to identify the most parsimonious model.
Results: The median age at TOF repair was 0.7 years (0.1-45), patient age was 18.1 years (0.8-72) and interval between Echo and CMR was 48 days (0-364). Diagnoses consisted of TOF/pulmonary stenosis (73%), TOF/pulmonary atresia (24%), and TOF/atrioventricular canal (3%). EDFF was identified in 122 (31%) patients. Compared with those without EDFF, patients with EDFF were younger (p=0.04); had a larger PR fraction (p<0.0001); and higher RV end-diastolic volume, (p=0.02) stroke volume (p<0.0001) and ejection fraction (p=0.009). There was no significant difference in the right atrial or left ventricular Echo and CMR indices between the 2 groups. On multivariable regression analysis, EDFF was independently associated with a larger RV stroke volume (p<0.0001), and a smaller left ventricular end-diastolic volume (p=0.001).
Conclusion: In this large cohort of repaired TOF patients, multimodality noninvasive imaging findings suggest mechanisms beyond right ventricular noncompliance may be responsible for presence of EDFF.
Author Disclosures: S. Kutty: None. A.M. Valente: None. M.T. White: None. K. Hickey: None. D.A. Danford: None. A.J. Powell: None. T. Geva: None.
- © 2016 by American Heart Association, Inc.