Right ventricular function in patients with pulmonary regurgitation with versus without tetralogy of Fallot

Guillermo Larios, Deane Yim, Andreea Dragulescu, Luc Mertens, Lars Grosse-Wortmann, Mark K. Friedberg

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Right ventricular (RV) dilation from pulmonary valve regurgitation (PR) is common after intervention(s) for pulmonary stenosis (PS) or atresia and intact ventricular septum (PA/IVS). It is not well established whether PR and RV dilation have similar effects on RV function and exercise capacity in these patients compared to patients after repair of tetralogy of Fallot (rToF). The aims of this study were to compare exercise tolerance, RV function and myocardial mechanics in non-ToF versus rToF children with significantly increased and comparable RV volumes. Methods: Thirty PS or PA/IVS children after intervention(s) with significant PR and RV dilation (non-ToF group) were retrospectively matched for RV end-diastolic volume index (RVEDVi) and age with 30 rToF patients. Clinical characteristics, RV function by echocardiography and CMR, ECG and exercise capacity were compared between groups. Results: The groups were well matched for RVEDVi and age. Global RV function (RVEF: 48.7 ± 6.4% vs. 48.5 ± 7.2%, P = .81) and exercise capacity (% predicted peak VO 2 :82.5 ± 17.7% vs. 75.6 ± 20.4%, P = .27) were similarly reduced between groups. RVEDVi correlated inversely with RVEF in both groups (non-ToF:r = −0.39, P = .04, rToF:r = −0.40, P = .03). QRS duration was wider in rToF patients, and in both groups inversely correlated with RVEF (non-ToF:r = −0.77, P < .001, rToF:r = −0.69, P < .001). In contrast to global function, longitudinal RV strain was lower in rTOF vs non-TOF (−20.1 ± 3.9 vs.-25.7 ± 4.4, P < .001). Conclusions: Global RV function and exercise capacity are similarly reduced in non-ToF and rToF patients with severely dilated RV, after matching by RVEDVi, suggesting a comparable impact of RV dilation on RV global function. The significance of reduced RV longitudinal function and worse dyssynchrony in rToF patients require further exploration.

Original languageEnglish (US)
Pages (from-to)8-17
Number of pages10
JournalAmerican heart journal
Volume213
DOIs
StatePublished - Jul 2019
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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