title: Aortopathy in adults with tetralogy of Fallot has a negative impact on the left ventricle.
abstract: BACKGROUND
  Aortic pressure wave reflection is significantly elevated in patients with congenital heart disease, even in children. Excessive aortic pressure wave reflection provokes cardiovascular events.
  
  
  OBJECTIVE
  To assess the influences of the enhanced pressure wave reflection on the left ventricle (LV) in adults with repaired tetralogy of Fallot (TOF).
  
  
  METHODS
  Prospectively, 51 consecutive adults with repaired TOF (35.5±11.6yrs., 25 males) were enrolled and non-invasively assessed the pressure wave reflection using HEM 9000AI. A surrogate maker of the aortic pressure wave reflection, radial augmentation index (rAI) was calculated as reflection wave divided by ejection wave. We also evaluated LV function using echocardiography and magnetic resonance images. Patients were divided into two groups: group A with rAI≧1SD and group B with rAI<1SD.
  
  
  RESULTS
  The mean rAI in repaired TOF was 76.9±14.3%. In group A, indexed ascending aortic diameter, LV global longitudinal strain (GLS), LV global circumferential strain (GCS), LV early diastolic strain rate (SR), LV E/A, LV e' were significantly higher than them in group B. The indexed ascending aortic diameter significantly correlated with rAI (r=0.31, P<0.05). On univariate logistic analysis, body surface area, indexed ascending aortic diameter, GLS, GCS, early diastolic SR, LV E/A, LV mass index and creatinine were predictive factors of rAI≧1SD. On multivariate logistic analysis, LV E/A was the most significant predictive factor of rAI≧1SD (Odds ratio 0.044, 95%CI 0.002-0.98 and P<0.05).
  
  
  CONCLUSIONS
  Aortic pressure wave reflection in adults with repaired TOF has a negative impact on LV function, particularly on diastolic function.
authors.affiliation: Cardiovascular Center, St. Luke's International Hospital, 9-1 Akashi, Tokyo 104-8560, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Shiina
authors.affiliation: Department of Cardiology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba 266-0007, Japan. Electronic address: murat@seagreen.ocn.ne.jp.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Cardiovascular Center, St. Luke's International Hospital, 9-1 Akashi, Tokyo 104-8560, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Kawamatsu
authors.affiliation: Cardiovascular Center, St. Luke's International Hospital, 9-1 Akashi, Tokyo 104-8560, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Niwa
mesh_terms: D000293:Adolescent; D000328:Adult; D062186:Arterial Pressure / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D013771:Tetralogy of Fallot / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult
keywords: Aortic pressure wave reflection; Augmentation index; Left ventricle; Tetralogy of Fallot