title: Doppler-echocardiographic assessment of pulmonary regurgitation in adults with repaired tetralogy of Fallot: comparison with cardiovascular magnetic resonance imaging.
abstract: OBJECTIVE
  The purpose of this study was to compare the noninvasive assessment of severity of pulmonary regurgitation with Doppler echocardiography versus cardiovascular magnetic resonance imaging (CMR) in adult patients with repaired tetralogy of Fallot (rTOF).
  
  
  METHODS
  We studied 52 (22 females) consecutive patients (aged 32 +/- 2 years, 23 +/- 5 years after rTOF) using Doppler echocardiography and compared these findings with CMR. From the continuous-wave Doppler trace, the duration of pulmonary regurgitation and of total diastole was measured and the ratio between the 2 was defined as pulmonary regurgitation index (PRi). Pulmonary regurgitant fraction (PRF) was assessed with flow phase velocity mapping with CMR.
  
  
  RESULTS
  Patients were divided into 2 groups according to the median value (24.5%) of PRF measured by CMR: Group I (26 patients) with PRF < or =24.5% and Group II with PRF >24.5%. There was no difference between patients' age, sex, or age at repair between the 2 groups. More patients from Group II had a right ventricular outflow or transannular patch repair compared to Group I (12/26 [46%] vs 6/26 [23%], P <.01). Mean pulmonary regurgitation time was shorter (340 +/- 60 vs 440 +/- 135 ms, P =.001) and PRi was lower (0.61 +/- 0.11 vs 0.91 +/- 0.11, P <.001) in Group II compared to Group I. Color Doppler regurgitant jet was also broader in Group II (1.4 +/- 0.4 vs 0.7 +/- 0.5 cm, P <.001), signifying more severe pulmonary regurgitation. Doppler-measured PRi correlated closely with CMR regurgitant fraction (r = -0.82, P <.001) and with color Doppler pulmonary regurgitant jet width (r = -0.66, P <.001); the latter correlated with PRF assessed with CMR (r = 0.72, P <.001). A PRi <0.77 had 100% sensitivity and 84.6% specificity for identifying patients with pulmonary regurgitant fraction >24.5%, with a predictive accuracy of 95%. Furthermore, echocardiographically-assessed right ventricular end-diastolic dimensions correlated with CMR end-diastolic volume index (r = 0.49, P <.001 ).
  
  
  CONCLUSIONS
  Pulmonary regurgitation is common in asymptomatic adults with rTOF. Severity of pulmonary regurgitation and its effects on right ventricular dimensions in these patients can be assessed noninvasively by Doppler echocardiography and CMR, with reasonable agreement between the 2 techniques.
authors.affiliation: Adult Congenital Heart Programme, Department of Cardiology, Royal Brompton Hospital and the National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Periklis A
authors.initials: PA
authors.lastname: Davlouros
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kilner
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.forename: Derek
authors.initials: D
authors.lastname: Gibson
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
mesh_terms: D000328:Adult; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology