title: Abnormal right atrial and right ventricular diastolic function relate to impaired clinical condition in patients operated for tetralogy of Fallot.
abstract: BACKGROUND
  Atrial enlargement may reflect ventricular diastolic dysfunction. Although patients with tetralogy of Fallot (TOF) have been studied extensively, little is known about atrial size and function. We assessed bi-atrial size and function in patients after TOF repair, and related them to biventricular systolic and diastolic function, and clinical parameters.
  
  
  METHODS
  51 Patients (21 ± 8 years) and 30 healthy controls (31 ± 7 years) were included and underwent magnetic resonance imaging to assess bi-atrial and biventricular size, systolic and diastolic function. Patients also underwent exercise testing, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) assessment.
  
  
  RESULTS
  In patients, right atrial (RA) minimal volume (34 ± 8 ml/m(2) vs. 28 ± 8 ml/m(2), p=0.001) and late emptying fraction were increased; RA early emptying fraction was decreased. Patients had longer right ventricular (RV) deceleration time (0.24 ± 0.10 vs. 0.13 ± 0.04, p<0.001), reflecting impaired RV relaxation, and larger RV volumes. Patients with end-diastolic forward flow (EDFF) had larger RA and RV size, abnormal RA emptying, higher NT-proBNP levels, higher VE/VCO2 slope (ventilatory response to carbon dioxide production), and the most abnormal LV diastolic function (impaired compliance). Patients with abnormal RA emptying (reservoir function <30% and pump function >24%) had higher NT-proBNP levels and worse exercise capacity. RA minimal volume was associated with RV end-diastolic volume (r=0.35, p=0.013).
  
  
  CONCLUSIONS
  In TOF patients with moderate RV dilatation, abnormal bi-atrial function and biventricular diastolic dysfunction are common. Abnormal RA emptying was associated with signs of impaired clinical condition, as was the presence of EDFF. These parameters, together with RA enlargement, could serve as useful markers for clinically relevant RV diastolic dysfunction.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Saskia E
authors.initials: SE
authors.lastname: Luijnenburg
authors.forename: Rosanne E
authors.initials: RE
authors.lastname: Peters
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van der Geest
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.forename: Yolanda B
authors.initials: YB
authors.lastname: de Rijke
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Willem A
authors.initials: WA
authors.lastname: Helbing
mesh_terms: D000293:Adolescent; D000328:Adult; D016280:Atrial Function, Right / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000096:biosynthesis; D010446:Peptide Fragments / Q000032:analysis / Q000096:biosynthesis; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain