title: Usefulness of right ventricular and right atrial two-dimensional speckle tracking strain to predict late arrhythmic events in adult patients with repaired Tetralogy of Fallot.
abstract: OBJECTIVE
  To determine whether right ventricular and/or atrial speckle tracking strain is associated with previous arrhythmic events in patients with repaired tetralogy of Fallot.
  
  
  RESULTS
  We studied right ventricular and atrial strain in 100 consecutive patients with repaired tetralogy of Fallot referred for routine echocardiographic evaluation. Patients were divided into two groups, one with previous documentation of arrhythmias (n=26) and one without arrhythmias, in a median follow-up of 22 years. Patients with arrhythmias were older (p<0.001) and had surgical repair at an older age (p=0.001). They also had significantly reduced right ventricular strain (-14.7±5.5 vs. -16.9±4.0%, p=0.029) and right atrial strain (19.1±7.7% vs. 25.8±11.4%, p=0.001). Neither right ventricular nor right atrial strain were independent predictors of the presence of a history of documented arrhythmias, which was associated with age at correction and with the presence of residual defects. In a subanalysis after excluding 23 patients who had had more than one corrective surgery, right ventricular strain was an independent predictor of the presence of previous arrhythmic events (OR 1.19, 95% CI 1.02-1.38, p=0.025). Right atrial strain was also an independent predictor after adjustment (OR 0.93, 95% CI 0.87-0.99, p=0.029). The ideal cut-off for right ventricular strain was -15.3% and for right atrial strain 23.0%.
  
  
  CONCLUSIONS
  Compared with conventional echocardiographic parameters, strain measures of the right heart are associated with the presence of arrhythmic events, and may be useful for risk stratification of patients with repaired tetralogy of Fallot, although a prospective study is required.
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal. Electronic address: ana_timoteo@yahoo.com.
authors.forename: Ana T
authors.initials: AT
authors.lastname: Timóteo
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: Luísa M
authors.initials: LM
authors.lastname: Branco
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: Sílvia A
authors.initials: SA
authors.lastname: Rosa
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: Ruben
authors.initials: R
authors.lastname: Ramos
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: Ana F
authors.initials: AF
authors.lastname: Agapito
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: Lídia
authors.initials: L
authors.lastname: Sousa
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Galrinho
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: José A
authors.initials: JA
authors.lastname: Oliveira
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: Mário M
authors.initials: MM
authors.lastname: Oliveira
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisboa, Portugal.
authors.forename: Rui C
authors.initials: RC
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery*; D013997:Time Factors
keywords: Arrhythmias; Arritmias; Repaired tetralogy of Fallot; Strain; Tetralogia de Fallot reparada