title: Left and right ventricular dyssynchrony and strains from cardiovascular magnetic resonance feature tracking do not predict deterioration of ventricular function in patients with repaired tetralogy of Fallot.
abstract: Patients with repaired tetralogy of Fallot (rTOF) suffer from progressive ventricular dysfunction decades after their surgical repair. We hypothesized that measures of ventricular strain and dyssynchrony would predict deterioration of ventricular function in patients with rTOF.
  
  
  
  A database search identified all patients at a single institution with rTOF who underwent cardiovascular magnetic resonance (CMR) at least twice, >6 months apart, without intervening surgical or catheter procedures. Seven primary predictors were derived from the first CMR using a custom feature tracking algorithm: left (LV), right (RV) and inter-ventricular dyssynchrony, LV and RV peak global circumferential strains, and LV and RV peak global longitudinal strains. Three outcomes were defined, whose changes were assessed over time: RV end-diastolic volume, and RV and LV ejection fraction. Multivariate linear mixed models were fit to investigate relationships of outcomes to predictors and ten potential baseline confounders.
  
  
  
  One hundred fifty-three patients with rTOF (23 ± 14 years, 50 % male) were included. The mean follow-up duration between the first and last CMR was 2.9 ± 1.3 years. After adjustment for confounders, none of the 7 primary predictors were significantly associated with change over time in the 3 outcome variables. Only 1-17 % of the variability in the change over time in the outcome variables was explained by the baseline predictors and potential confounders.
  
  
  
  In patients with repaired tetralogy of Fallot, ventricular dyssynchrony and global strain derived from cine CMR were not significantly related to changes in ventricular size and function over time. The ability to predict deterioration in ventricular function in patients with rTOF using current methods is limited.
authors.affiliation: Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA, 17822-4400, USA.
authors.forename: Linyuan
authors.initials: L
authors.lastname: Jing
authors.affiliation: Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wehner
authors.affiliation: Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA, 17822-4400, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Suever
authors.affiliation: Department of Biostatistics, University of Kentucky, Lexington, KY, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Charnigo
authors.affiliation: Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.
authors.forename: Sudad
authors.initials: S
authors.lastname: Alhadad
authors.affiliation: Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Stearns
authors.affiliation: Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Mojsejenko
authors.affiliation: Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA, 17822-4400, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Haggerty
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Hickey
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Valente
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: Tal
authors.initials: T
authors.lastname: Geva
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Powell
authors.affiliation: Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA. bkf@gatech.edu.|Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA, 17822-4400, USA. bkf@gatech.edu.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Fornwalt
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001696:Biomechanical Phenomena; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007629:Kentucky; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult
keywords: Cardiac strain; Cardiovascular magnetic resonance; Congenital heart disease; Dyssynchrony; Tetralogy of Fallot