The relationship between extracellular volume fraction in symptomatic adults with tetralogy of Fallot and adverse cardiac events

Abstract

The most common long-term complication in postoperative tetralogy of Fallot (TOF) is pulmonary regurgitation (PR) [1]. PR is primarily the result of transannular patching and it leads to progressive right ventricular (RV) enlargement, dysfunction, and eventual right heart failure [1]. Myocardial impairment also provokes ventricular arrhythmias [2]; however, it is still unknown whether late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) can be a predictor of all cardiovascular events, because LGE imaging fails to characterize diffuse and/or mild myocardial impairments [3]. A novel technique of CMR known as T1 mapping can detect diffuse interstitial myocardial changes. Several studies have reported that increased biventricular extracellular volumes (ECV) are associated with RV volume overload [3][4][5]. Furthermore, RVand/or left ventricle (LV)-ECV can be used to predict clinical outcomes or exercise capacity in TOF [3,4]; however, these results remain controversial. Some studies reported that LV-ECV was the most important predictor of cardiac events, but others reported RV-ECV was relevant, not LV-EDV [3][4][5]. Therefore,

Evaluation of right ventricular myocardial properties using systolic myocardial T1 mapping

“…Consistent with previous reports, patients with right ventricular myocardial injury had elevated right ventricular myocardial T1 values [13][14]. The right ventricular myocardial T1 value is known to be elevated in patients with pulmonary hypertension and after surgery for tetralogy of Fallot.…”

“…The right ventricular myocardial T1 value is known to be elevated in patients with pulmonary hypertension and after surgery for tetralogy of Fallot. But, in previous reports, the right ventricular myocardial T1 value was evaluated during diastole [13][14]. The validity of the diastolic right ventricular myocardial T1 value has been cited as a limitation in all the previous reports.…”