title: Resting heart rate influences right ventricular volume in repaired tetralogy of Fallot.
abstract: The aim of this study is to examine the impact of heart rate (HR) on right ventricular end-diastolic volume indexed to body surface area (RVEDVi) in patients with repaired tetralogy of Fallot (TOF). In this cross-sectional study, an institutional database search identified all patients with repaired TOF who underwent cardiac magnetic resonance (CMR) and had a Holter study within 3 months. The association of HR on Holter, HR at the time of CMR, and other clinical and CMR parameters on RVEDVi was explored with univariate and then multivariable models. In the study group (n = 161, median age 23 years), a lower mean Holter HR was associated with a larger RVEDVi (p = 0.004). In a model that also included pulmonary regurgitation fraction, tricuspid regurgitation grade, RV ejection fraction, age at CMR, and gender, mean Holter HR remained associated with RVEDVi (p < 0.0001); for a decrease of 1 bpm, mean RVEDVi increased by 1.09 ml/m(2). When limiting to those with a Holter within 5 days of CMR (n = 70), the impact of mean Holter HR on RVEDVi was stronger (-1.9 ml/m(2)/bpm). HR at time of CMR had a significant but less pronounced relationship to RVEDVi (-0.58 ml/m(2)/bpm, p = 0.002). In conclusion, in repaired TOF patients, a lower HR was significantly associated with a larger RVEDVi. This relationship was stronger with a shorter time interval between the Holter and CMR, and stronger for the mean HR on Holter than for the HR at CMR. Accounting for HR in the interpretation of RVEDVi may impact decisions regarding pulmonary valve replacement and the interpretation of serial CMR data.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA, matthew.jolley@childrens.harvard.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Jolley
authors.forename: Kelsey
authors.initials: K
authors.lastname: Hickey
authors.forename: David
authors.initials: D
authors.lastname: Annese
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Tal
authors.initials: T
authors.lastname: Geva
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Valente
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Powell
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D003430:Cross-Sectional Studies; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000601:surgery; D013771:Tetralogy of Fallot / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000601:surgery; D055815:Young Adult