BackgroundPatients 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.MethodsA 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.ResultsOne 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.ConclusionsIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-016-0268-8) contains supplementary material, which is available to authorized users.

An ERAS protocol for VHR demonstrated improved patient outcomes. A system-wide culture focused on enhanced recovery is needed to ensure improved patient outcomes.

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Objectives: Patients with repaired tetralogy of Fallot (rTOF) suffer from progressive ventricular dysfunction decades after their initial surgical repair. This study sought to determine whether measures of ventricular strain and dyssynchrony could predict deterioration of ventricular function in patients with rTOF. Methods: A database search identified all patients at a single institution with rTOF who underwent cardiac magnetic resonance (CMR) at least twice, greater than 6 months apart, without intervening surgical or catheter procedures. Five primary potential predictors were derived from the first CMR using a custom feature tracking algorithm: left (LV), right (RV) and inter-ventricular dyssynchrony, and LV and RV peak circumferential strains. Three outcomes were defined as measures of progression over time: RV end-diastolic volume, RV ejection fraction (EF), and LV EF. A multivariate linear mixed model, subject to backward elimination of extraneous terms, was fit to investigate relationships between predictors and outcomes. Ten potential confounders (see table footnote) measured at baseline were also included in the model. Results: A cohort of 153 patients with rTOF (23±14 years, 50% male) were included. The mean time between the first and last CMR was 2.9±1.3 years. None of the 5 primary predictors were significantly associated with change over time in the 3 outcomes in the multivariate model, though RV circumferential strain was associated with RV EF at baseline (table). Only 1-16% of the variability in the change over time in the 3 outcomes could be explained by the predictors in the multivariate model. Conclusions: In patients with rTOF, measures of ventricular dyssynchrony and strain were not significantly related to changes in ventricular size and function over time in a multivariate analysis. The ability to predict deterioration in ventricular function using all potential predictors is limited.

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