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Left Atrial Strain in the Repaired Tetralogy of Fallot Population: Comparisons to Biventricular Function, Native T1 Values, Exercise Parameters and Healthy Controls

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Abstract

Background

Non-invasive imaging markers in patients with repaired tetralogy of Fallot (rTOF) are still being investigated to inform clinical decision making. Atrial function is a prognostic indicator in many acquired and congenital heart diseases. We sought to examine the relationship between cardiac MRI (CMR)-derived indices of left atrial (LA) function, native left ventricular (LV) T1 values, biventricular systolic function, and exercise capacity in rTOF.

Methods

Sixty-six patients with rTOF without prior pulmonary valve replacement who underwent CMR (median age 18.5 years) were identified. Twenty-one adult rTOF patients (age range 19–32 years) were compared with 20 age-matched healthy volunteers (age range 19–34 years). LA reservoir, conduit, and pump global longitudinal strain (GLS) and strain rate (SR) were determined by tissue tracking. Native LV T1 values were measured on rTOF patients. Pearson correlations were performed to determine bivariate associations.

Results

Adult rTOF patients had higher pump GLS, pump:conduit, and pump:reservoir GLS ratios, and lower conduit:reservoir GLS ratio, LV ejection fraction (EF), and right ventricular EF compared to controls (p < 0.001 for each comparison). LA conduit:reservoir GLS and pump:reservoir GLS had correlations to native LV T1 (ρ = 0.26, p = 0.03 and ρ = − 0.26, p = 0.03, respectively). LA reservoir SR had positive correlation to RV EF (ρ = 0.27, p = 0.03). There were no statistically significant correlations between LA function and exercise capacity.

Conclusions

LA function is altered in adolescent and young adult patients with rTOF indicating worse diastolic function and relates to increasing native LV T1 values. Future studies are indicated to investigate the progression of adverse atrial-ventricular interactions and poor outcomes in this population.

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Funding

This work was conducted with support from the Heart Institute Research Core (HIRC) at Cincinnati Children’s Hospital.

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Authors and Affiliations

  1. Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA

    Hieu T. Ta, Tarek Alsaied, Paul J. Critser, Joshua Germann, Adam W. Powell, Sean Lang, Andrew N. Redington & Justin T. Tretter

  2. Department of Cardiology, The Christ Hospital Health Network, Cincinnati, OH, USA

    Vien T. Truong & Wojciech Mazur

  3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Tarek Alsaied, Nicholas J. Ollberding, Philip R. Khoury, Adam W. Powell, Sean Lang, Andrew N. Redington & Justin T. Tretter

  4. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Nicholas J. Ollberding & Philip R. Khoury

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  1. Hieu T. Ta
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  2. Vien T. Truong
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Correspondence to Justin T. Tretter.

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Ta, H.T., Truong, V.T., Alsaied, T. et al. Left Atrial Strain in the Repaired Tetralogy of Fallot Population: Comparisons to Biventricular Function, Native T1 Values, Exercise Parameters and Healthy Controls. Pediatr Cardiol 42, 1102–1110 (2021). https://doi.org/10.1007/s00246-021-02587-0

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  • DOI: https://doi.org/10.1007/s00246-021-02587-0

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