title: Assessment of ventricular function in adults with repaired Tetralogy of Fallot using myocardial deformation imaging.
abstract: OBJECTIVE
  Many patients with repaired Tetralogy of Fallot (ToF) have right ventricular (RV) volume overload due to pulmonary regurgitation (PR). We studied the effect of volume overload on global and regional RV and left ventricular (LV) deformation, and their relationships with conventional diagnostic parameters.
  
  
  RESULTS
  In this cross-sectional study, 94 prospectively recruited ToF patients (61% male, age 32.8 ± 9.5 years, age at repair 1.9 [0.8-5.7] years, 39% pulmonary homograft) and 85 healthy controls of similar age and sex underwent echocardiography and electrocardiography. In a subset of patients, cardiac magnetic resonance imaging, bicycle ergometry, and NT-proBNP measurement were performed within the same day. With speckle-tracking echocardiography, we analysed peak systolic global longitudinal strain (GLS), segmental longitudinal strain and strain rate of the RV free wall, LV lateral wall, and septum. Patients had a lower RV free wall strain than controls (-18.1 ± 4.5 vs. -26.5 ± 4.5%, P < 0.001), especially at the apical segment (-15.9 ± 7.4 vs. -28.2 ± 7.7%, P < 0.001), and lower RV strain rate. LV GLS was also lower (-17.4 ± 2.5 vs. -19.6 ± 1.9%, P < 0.001), mainly due to the interventricular septum. Patients with PR >25% had higher LV GLS and RV free wall strain than patients with PR ≤25% (P = 0.004, P = 0.039, respectively). No relationships were found with NT-proBNP or exercise capacity.
  
  
  CONCLUSIONS
  RV free wall strain and strain rate are decreased in adults late after ToF repair, especially at the apical segment suggesting that apical function is most affected in these RVs. Regarding the LV, septal strain is decreased indicating that RV dysfunction adversely affects LV function, probably by mechanical coupling of the ventricles.
authors.affiliation: Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Myrthe E
authors.initials: ME
authors.lastname: Menting
authors.affiliation: Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Annemien E
authors.initials: AE
authors.lastname: van den Bosch
authors.affiliation: Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Jackie S
authors.initials: JS
authors.lastname: McGhie
authors.affiliation: Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Jannet A
authors.initials: JA
authors.lastname: Eindhoven
authors.affiliation: Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Judith A A E
authors.initials: JA
authors.lastname: Cuypers
authors.affiliation: Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Witsenburg
authors.affiliation: Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Sophia's Children's Hospital-Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Helbing
authors.affiliation: Department of Cardiology, Thorax Centre, Erasmus MC, Rotterdam, the Netherlands j.roos@erasmusmc.nl.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Tetralogy of Fallot; myocardial deformation; speckle-tracking echocardiography; strain; strain rate