A fast cardiovascular magnetic resonance (CMR) feature tracking was applied to assess ventricular systolic and diastolic function. This study sought to detect right ventricular (RV) systolic and diastolic abnormalities in asymptomatic pediatric repaired tetralogy of Fallot (rTOF) patients with preserved RV ejection fraction (EF).
One hundred asymptomatic pediatric rTOF patients with preserved RVEF ≥ 45% and 52 control subjects underwent cine CMR examinations. Tricuspid annular plane systolic excursion (TAPSE); peak tricuspid annular systolic (Sm), early diastolic (Em), and late diastolic (Am) velocities; and biventricular global radial (GRS), circumferential (GCS), and longitudinal strains (GLS) were analyzed using CMR feature tracking.
TAPSE, Sm, Em, Am, and RV GLS were significantly lower in rTOF patients compared with controls (all p < 0.01). The lower limits (mean–2·standard deviations) of TAPSE, Sm, Em, and Am among controls were 10.9 mm, 6.3 cm/s, 8.9 cm/s, and 2.4 cm/s, respectively, and 78%, 75%, 75%, and 19% of rTOF patients had corresponding measurements below these thresholds. Among rTOF patients, RV GLS was significantly lower in females than in males (p < 0.05).
Despite preserved RVEF, there was a high prevalence of RV systolic and diastolic dysfunction among pediatric rTOF patients, which was detected using fast CMR feature tracking.
• There was high prevalence of systolic and diastolic dysfunction in asymptomatic pediatric repaired tetralogy of Fallot (rTOF) patients despite preserved right ventricular (RV) ejection fraction (EF).
• Significant correlations were observed between right ventricular (RV) measurements (strains, tricuspid annular plane systolic excursion (TAPSE), peak tricuspid annular early diastolic velocity (E m ), peak tricuspid annular late diastolic velocity (A m )), and left ventricular (LV) strain measurements, which indicates ventricular–ventricular interactions at systolic and diastolic function level.
• Right ventricular (RV) global longitudinal strain (GLS) was lower in female repaired tetralogy of Fallot (rTOF) patients than in males, suggesting females with rTOF may be at a higher risk of developing RV systolic dysfunction than males.
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- A m :
Peak tricuspid annular late diastolic velocity
Body surface area
Cardiovascular magnetic resonance
- E m :
Peak tricuspid annular early diastolic velocity
Global circumferential strain
Global longitudinal strain
Global radial strain
Late gadolinium enhancement
Repaired tetralogy of Fallot
- S m :
Peak tricuspid annular systolic velocity
Tricuspid annular plane systolic excursion
Tetralogy of Fallot
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The authors would like to thank Xiaofen Yao and Lijun Chen who helped with the data collection.
This study has received funding from the National Key Research and Development Program of China (No. 2018YFB1107100), the Shanghai Committee of Science and Technology (No. 17411965400), the Key Projects of Shanghai Science and Technology Commission (No. 17411953300), the Shanghai Municipal Commission of Health and Family Planning (No. 201740095), and the Singapore National Medical Research Council (NMRC/OFIRG/0018/2016, MOH-000351).
The scientific guarantor of this publication is Yumin Zhong.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
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Ouyang, R., Leng, S., Sun, A. et al. Detection of persistent systolic and diastolic abnormalities in asymptomatic pediatric repaired tetralogy of Fallot patients with preserved ejection fraction: a CMR feature tracking study. Eur Radiol (2021). https://doi.org/10.1007/s00330-020-07643-6
- Magnetic resonance imaging
- Tetralogy of Fallot
- Right ventricular function