Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of Fallot: New insights in cardiac mechanics and exercise capacity

• Published in: International journal of cardiology Vol. 321; pp. 144 - 149
• Main Authors: Avesani, Martina, Borrelli, Nunzia, Krupickova, Sylvia, Sabatino, Jolanda, Donne, Grazia Delle, Ibrahim, Aladino, Piccinelli, Enrico, Josen, Manjit, Michielon, Guido, Fraisse, Alain, Iliceto, Sabino, Di Salvo, Giovanni
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.12.2020
• Subjects: Adolescent; Cardiac magnetic resonance; Child; Echocardiography; Exercise Tolerance; Humans; Magnetic Resonance Imaging, Cine; Magnetic Resonance Spectroscopy; Pulmonary regurgitation; Reproducibility of Results; Right atrial strain; Tetralogy of Fallot; Tetralogy of Fallot - diagnostic imaging; Tetralogy of Fallot - surgery; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology; Ventricular Function, Right; Tetralogy of Fallot; RVGLS; PR; RVEF; RAS; PRi; EDA/ESA; ROC; ICC; FAC; CMR; TAPSE; r-TOF; RVOT; AUC; Right atrial strain; SD; BSA; RF; Pulmonary regurgitation; Cardiac magnetic resonance; EDV/ESV; PHT
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2020.07.026

Pulmonary regurgitation (PR) and right ventricular (RV) dilatation and disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF). To compare Echo data with the gold standard CMR in a paediatric population of r-TOF with significant PR, to assess the reliability of standard and advanced echo parameters. In addition, to evaluate their correlation with peak oxygen consumption (VO2). All patients underwent standard echo-Doppler study, speckle tracking analysis, and CMR to assess PR and RV size and function. Thirty-six patients underwent also cardiopulmonary exercise test. Fourty-six patients (aged 13.7 ± 3.0) were included. Echo derived RV areas correlated with CMR RV volumes (p < .0001, r = 0.72). RV end-diastolic area > 21.9 cm2/m2 had a good sensitivity (83.3%) and specificity (73.5%) to identify a RV end-diastolic volume ≥ 150 ml/m2. RVEF was preserved in all patients, while TAPSE was reduced in 78.2% and RVGLS in 60.8%. Flow-reversal in pulmonary branches showed a sensitivity of 95.8% and a specificity of 59.1% to identify CMR pulmonary regurgitant fraction (RF) ≥ 35%. None of the CMR parameters correlated with peak VO2. Among the Echo data only right atrial strain (RAS) correlated with peak VO2. In children, flow-reversal in pulmonary branches identifies hemodynamically significant RF with a good sensitivity but poor specificity. RV area by echocardiogram is a valid first-line parameter to screen RV dilation. RV longitudinal systolic dysfunction coexists with a still preserved EF. RAS correlates strongly with peak VO2 and should be added in their follow up. •In children with repaired Tetralogy of Fallot RV area by echocardiogram is a valid first line parameter to screen RV dilation as compared with CMR.•Right ventricle longitudinal systolic dysfunction coexists with a still preserved RV EF.•Flow-reversal in pulmonary branches identifies PR RF ≥ 35% at CMR.•The only parameter correlated to peak Vo2 max in children with r-TOF is right atrial strain