Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices

Egbe, Alexander C.; Banala, Keerthana; Vojjini, Rahul; Jadav, Raja; Sufian, Mahir; Pellikka, Patricia A.; Ammash, Naser M.

doi:10.1016/j.ijcha.2019.100457

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…As long-term survival with rToF is improving, the importance of understanding the hemodynamics of these congenital heart defects become apparent [ 16 ] while timing of PVR after initial surgical correction remains debated [ 17 ]. A better understanding of the intrinsic relationship between the left and right sides of the heart in rToF and the importance of intracardiac pressures [ 18 ] will aid in developing non-invasive measurements and to guide future therapeutic interventions.…”

Section: Discussionmentioning

confidence: 99%

Right ventricular longitudinal function is linked to left ventricular filling pressure in patients with repaired tetralogy of fallot

Johansson

Binka

Barnes

et al. 2022

Int J Cardiovasc Imaging

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Experimental data on pulmonary regurgitation has linked right ventricular longitudinal function to left ventricular filling pressure in animals with induced and treated pulmonary regurgitation but this relationship has not been investigated in patients with repaired Tetralogy of Fallot (rToF). The aim of this study was to determine if right ventricular longitudinal function assessed using cardiovascular magnetic resonance (CMR) is associated with left ventricular filling pressure in patients with rToF. A second objective of this study was to determine if direction of septal movement is related to right ventricular pressure load in rToF. Eighteen patients with rToF undergoing CMR and heart catheterization prior to pulmonary valve replacement were retrospectively included and catheter-based pressure measurements were compared with CMR-derived RV regional function. Left ventricular filling pressure was measured as precapillary wedge pressure (PCWP). Longitudinal contribution to RV stroke volume correlated with PCWP (r = 0.48; p = 0.046) but not with RV EF or pulmonary regurgitation. Neither RV longitudinal strain nor TAPSE showed correlation with PCWP. Longitudinal contribution to stroke volume was lower for the RV compared to the LV (49 vs 54%; p = 0.039). Direction of septal movement did not show a correlation with RV end-systolic pressure. Right ventricular longitudinal pumping is associated with left ventricular filling pressure in rToF-patients and this inter-ventricular coupling may explain LV underfilling in patients with pulmonary regurgitation and rToF and may be of value to determine right ventricular dysfunction. RV systolic pressure, however, cannot be assessed from the direction of septal movement, in these patients.

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Section: Discussionmentioning

confidence: 99%

Right ventricular longitudinal function is linked to left ventricular filling pressure in patients with repaired tetralogy of fallot

Johansson

Binka

Barnes

et al. 2022

Int J Cardiovasc Imaging

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“…In concordance with these findings, we found that LA compliance was the best predictor of h-LTA. Normalizing LA strain to estimated filling pressures ( E / e ′) may be more acurate to detect elevated filling pressure in the specific population of cTOF in whom standard parameters were reported to be less performant compared to general population ( 35 ). Our findings are in keeping with previous studies having demonstrated the potential interest of another combined echocardiographic parameters including LA stiffness estimated with the ratio ( E / E ′)/LAS ( 36 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

“…As previously mentioned, there is a growing body of evidence on the importance of precisely evaluating LV function and LV filling pressures in c-ToF. Egbe et al found indexed LA volume to have a moderate discriminatory ability to dectect LV elevated pressure and demonstrated that most of the echocardiographic indices endorsed by the practice guidelines ( 35 ) had very poor performance in the assessment of left heart filling pressures in the c-TOF population. The use of other echocardiographic indices for evaluating LV filling pressure therefore appears necessary in this specific population.…”

Section: Discussionmentioning

confidence: 99%

Abnormal left atrial compliance is associated with a history of life-threatening arrhythmia in corrected Tetralogy of Fallot

Vautier

Mulet

Macquaire

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesThe objectives of this study were to examine left atrial (LA) function and compliance using two-dimensional (2D) strain analysis in adult patients with corrected Tetralogy of Fallot (c-ToF) and to investigate the relationships between LA function and patient characteristics, especially history of life-threatening arrhythmia (h-LTA).MethodsFifty-one c-ToF patients (34 males; age, 39 ± 15 years; h-LTA, n = 13) were included in this retrospective monocenter study. In addition to a 2D standard echocardiography examination, 2D strain analysis was performed to assess left ventricular (LV) and LA functions, including peak-positive LA strain (LAS—reservoir function) and LA compliance [defined as the ratio LAS/(E/Ea)].ResultsPatients with h-LTA were older and exhibited a longer QRS duration. LV ejection fraction, LAS and LA compliance were significantly lower in the group of patients with h-LTA. Indexed LA and RA volumes, RV end-diastolic area was significantly higher and RV fractional area change significantly lower in the h-LTA group. LA compliance was the best echocardiographic predictor for h-LTA (AUC: 0.839; p < 0.001). Moderate inverted correlations were found between LA compliance and age and QRS duration. Among the echocardiographic parameters, LA compliance was moderately inversely correlated with RV end-diastolic area (r = −0.40, p = 0.01).ConclusionWe documented abnormal LAS and LA compliance values in adult c-ToF patients. Further study is needed to determine how best to incorporate LA strain, particularly LA compliance, into multiparametric predictive models for LTA in c-ToF patients.

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“…Similar observations have been reported in other forms of congenital heart disease, such as tetralogy of Fallot and coarctation of the aorta. [24][25][26] It should be noted that the cut-off value of >15 mm Hg may be insensitive for otherwise young healthy adults, and thus the prevalence of underlying increase in left filling pressures might have been underestimated. There was a lower prevalence of ≥moderate RV dysfunction in patients with abnormal PAWP.…”

Section: Left-sided Disease and The Role Of The Truncal Valvementioning

confidence: 99%

Surgical Repair of Truncus Arteriosus: A Long-Term Hemodynamic Assessment

Miguel

Jain

Egbe

et al. 2022

World J Pediatr Congenit Heart Surg

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Background: Unrepaired truncus arteriosus (TA) carries poor prognosis due to complications of unrestricted pulmonary flow, truncal valve insufficiency, and pulmonary vascular disease. Currently, the hemodynamic profile of adults late after TA repair is unknown. We reviewed the hemodynamics, prevalence, and pathophysiology of pulmonary hypertension (PH) in this population. Methods: Eighteen adult patients with repaired TA who underwent cardiac catheterization at Mayo Clinic, MN, between 1997 and 2021 were identified. PH was defined as either precapillary (mean pulmonary artery pressure [mPAP] ≥25 mm Hg, pulmonary artery wedge pressure [PAWP] ≤15 mm Hg, and pulmonary vascular resistance [PVR] >3 Wood units), isolated postcapillary (mPAP ≥25, PAWP >15, PVR ≤3), or combined (mPAP ≥25, PAWP >15, and PVR >3). Diastolic pressure and transpulmonary gradients were used as ancillary data for classification. Results: Mean age at catheterization was 34 ± 10 years. Mean right ventricular (RV) systolic pressure was 82 ± 22.6 mm Hg, mean right and left mPAPs 28.1 ± 16.2 and 27.9 ± 11.9 mm Hg, respectively. Seven patients (41.2%) had PAWP >15 mm Hg and, among those undergoing arterial catheterization, 7 (53.8%) had a left ventricular (LV) end-diastolic pressure >15 mm Hg. PH was diagnosed in 13 patients (72.2%): 6 (33.3%) precapillary, 4 (22.2%) isolated postcapillary, and 3 (16.7%) combined. PAWP >15 mm Hg was associated with male sex ( P = .049), <moderate RV dysfunction ( P = .049), and lesser RV conduit mean systolic gradient ( P = .02). Patients with PH with precapillary component were older at catheterization ( P = .046). Conclusions: In adults with repaired TA, precapillary PH was only present in one-third of patients with mPAPs not significantly increased in most, whereas elevated PAWP and left-heart disease were common.

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Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices

Cited by 7 publications

References 21 publications

Right ventricular longitudinal function is linked to left ventricular filling pressure in patients with repaired tetralogy of fallot

Right ventricular longitudinal function is linked to left ventricular filling pressure in patients with repaired tetralogy of fallot

Abnormal left atrial compliance is associated with a history of life-threatening arrhythmia in corrected Tetralogy of Fallot

Surgical Repair of Truncus Arteriosus: A Long-Term Hemodynamic Assessment

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