Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-15T03:22:19.108Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  18 June 2019

Adam M. Lubert Open the ORCID record for Adam M. Lubert [Opens in a new window] ,
Timothy B. Cotts ,
Jeffrey D. Zampi ,
Sunkyung Yu  and
Mark D. Norris
Adam M. Lubert*
Affiliation:
Cincinnati Children’s Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Timothy B. Cotts
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, MI, USA
Jeffrey D. Zampi
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, MI, USA
Sunkyung Yu
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, MI, USA
Mark D. Norris
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, MI, USA
*
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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Tetralogy of Fallotadult congenital heart diseaseechocardiographydiastolic dysfunction
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 8 , August 2019 , pp. 1020 - 1024
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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: 975–981.10.1016/S0140-6736(00)02714-8CrossRefGoogle ScholarPubMed
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: 178–181.10.1055/s-2007-1013719CrossRefGoogle ScholarPubMed
Khairy, P, Harris, L, Landzberg, MJ, et al. Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation 2008; 117: 363–370.10.1161/CIRCULATIONAHA.107.726372CrossRefGoogle ScholarPubMed
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: 128–132.10.1007/s002460010178CrossRefGoogle ScholarPubMed
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: 213–218.10.1136/hrt.2003.029280CrossRefGoogle ScholarPubMed
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: 1798–1802.10.1016/j.amjcard.2010.08.021CrossRefGoogle ScholarPubMed
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: 868–875.10.1161/CIRCULATIONAHA.109.928481CrossRefGoogle ScholarPubMed
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: 1321–1360.10.1093/ehjci/jew082CrossRefGoogle ScholarPubMed
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: 277–314.10.1016/j.echo.2016.01.011CrossRefGoogle ScholarPubMed
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: 866–872.10.1016/j.cjca.2012.11.003CrossRefGoogle ScholarPubMed
Vasan, RS, Benjamin, EJ, Levy, D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995; 26: 1565–1574.10.1016/0735-1097(95)00381-9CrossRefGoogle Scholar
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.2015.00003CrossRefGoogle ScholarPubMed
Swamy, P, Bharadwaj, A, Varadarajan, P, Pai, RG. Echocardiographic evaluation of tetralogy of Fallot. Echocardiography 2015; 2: S148–S156.10.1111/echo.12437CrossRefGoogle Scholar
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: 125–131.10.1016/j.ijcard.2017.02.153CrossRefGoogle ScholarPubMed
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: 905–913.10.1093/ehjci/jes067CrossRefGoogle ScholarPubMed
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: 866–873.10.1016/j.echo.2012.05.011CrossRefGoogle ScholarPubMed
Supplementary material: File

Lubert et al. supplementary material

Table S1

Download Lubert et al. supplementary material(File)
File 16.8 KB