title: Determinants of left- and right‑ventricular ejection fractions in patients with repaired tetralogy of Fallot: a cardiac magnetic resonance imaging study.
abstract: BACKGROUND
  There are inconsistent data regarding the factors affecting left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) in patients after tetralogy of Fallot (TOF) repair.
  
  
  OBJECTIVE
  The aim of the study was to assess the determinants of LVEF and RVEF in a large cohort of patients with repaired TOF.
  
  
  METHODS
  The study comprised 122 patients with repaired TOF (median age, 24.2 years; interquartile range, 20.3-30.9; men, 60.6%) who had undergone cardiac magnetic resonance imaging study. Predictors of LVEF, RVEF, and RVEF corrected for shunting or regurgitations (cRVEF) were identified with the use of linear regression analyses.
  
  
  RESULTS
  There was a weak correlation between RVEF and LVEF (r = 0.39, P <0.0001). A multiple regression analysis revealed the following independent predictors of LVEF: positive predictor - RVEF (P = 0.0002); negative predictors - pulmonary regurgitation fraction (PRF, P = 0.01) and male sex (P = 0.001). RVEF was predicted independently by positive predictors such as LVEF (P <0.0001) and LV end‑diastolic volume (LVEDV, P = 0.04) and negative predictors such as right ventricular mass (P <0.0001) and number of previous cardiothoracic surgery interventions (P = 0.005). In the model predicting cRVEF, only left ventricular mass was a positive predictor of cRVEF (P <0.0001), while right ventricular mass (P <0.0001), PRF (P <0.0001), male sex (P <0.0001), and RV late gadolinium enhancement score (P = 0.008) were negative predictors of cRVEF.
  
  
  CONCLUSIONS
  Because PRF was inversely and independently correlated with LVEF, and LVEDV showed a positive and independent correlation with RVEF, left ventricular disease (low LVEF and LVEDV due to left ventricular compression) may be used as a marker of the severity of right ventricular disease (pulmonary regurgitation severity and its consequences). Further studies are needed to evaluate the role of LVEF and LVEDV in supporting patient selection for pulmonary valve replacement.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Spiewak
authors.forename: Lukasz A
authors.initials: LA
authors.lastname: Małek
authors.forename: Joanna
authors.initials: J
authors.lastname: Petryka
authors.forename: Lukasz
authors.initials: L
authors.lastname: Mazurkiewicz
authors.forename: Magdalena
authors.initials: M
authors.lastname: Marczak
authors.forename: Elżbieta K
authors.initials: EK
authors.lastname: Biernacka
authors.forename: Mirosław
authors.initials: M
authors.lastname: Kowalski
authors.forename: Piotr
authors.initials: P
authors.lastname: Hoffman
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.forename: Jolanta
authors.initials: J
authors.lastname: Miśko
authors.forename: Witold
authors.initials: W
authors.lastname: Rużyłło
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology; D012044:Regression Analysis; D012422:Rupture, Spontaneous / Q000175:diagnosis / Q000503:physiopathology; D012737:Sex Factors; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult