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Atrial size and function have been recognized as markers of diastolic function, and diastolic dysfunction has been identified as a predictor of adverse outcomes in repaired tetralogy of Fallot (rTOF). This was a retrospective single-center study with the objective of investigating the use of atrial measurements obtained via CMR for predicting outcomes in rTOF patients. Automated contours of the left and right atria (LA and RA) were performed. A novel parameter, termed the Right Atrioventricular Coupling Index (RACI), was defined as the ratio of RA end-diastolic volume to right ventricle (RV) end-diastolic volume. Patients were risk-stratified using a previously validated Importance Factor Score for the prediction of life-threatening arrhythmias in rTOF. Patients with a high-risk Importance Factor Score (>2) had a significantly larger minimum RA volume (p = 0.04) and RACI (p = 0.03) compared to those with scores ≤2. ROC analysis demonstrated RACI to be the best overall predictor of a high-risk Importance Factor Score (AUC 0.73, p = 0.03). Older age at the time of repair and a diagnosis of pulmonary atresia were associated with a larger RACI. Automated atrial CMR measurements are easily obtained from standard CMRs and have the potential to serve as noninvasive predictors of adverse outcomes in rTOF.

It is widely accepted that regular exercise and physical activity (PA) reduce the risk of many chronic diseases. Not participating in PA is reported to be the biggest public health concern of the 21st century. New evidence suggests that time spent in sedentary behaviors presents an independent cardiovascular and metabolic disease risk. PURPOSE: To examine time spent in PA and inactivity as well as to compare accelerometry to self-reported inactive time. METHODS: Subjects (n=49) reported to the laboratory on 2 separate occasions. At the first visit, participants completed the Paffenbarger questionnaire (PAFF) to assess baseline activity and sedentary patterns. Also, the activPAL3 accelerometer was placed on the subjects' thigh and worn continuously for 7 consecutive days to obtain objective measures of PA and sedentary behavior. The subjects returned to the lab 8 days later to return the accelerometer and complete the PAFF questionnaire again for the timeframe the activPAL3 was worn. RESULTS: Accelerometry revealed that mean time spent (hrs/day) was: 18.58 (+1.2) being inactive, 3.43(+.89) standing, and 1.99 (+.52) stepping. A strong inverse relationship (r= -.726) exists between mean inactivity and mean steps/day. Those who met the 10,000 steps/day recommendation (55.1%) had significantly less time spent in inactivity (p<.001) than those who did not. Significantly more time (p<.01) was found between the number of steps taken during the week as compared to the weekend. However, there was no significant difference between mean inactive time during the week as compared to the weekend. Participants self-reported significantly less time spent in inactivity than accelerometer recorded (p<.01).

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