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Assessment of early diastolic intraventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot

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Abstract

Assessment of left ventricular (LV) dysfunction is vital in patients with repaired tetralogy of Fallot (rTOF). The early diastolic intraventricular pressure gradient (IVPG) in the LV plays an important role in diastolic function. IVPG is calculated as the intraventricular pressure difference divided by the LV length, which allows to account for differences in LV size and therefore calculate IVPG in children. We aimed to investigate the mechanisms of LV diastolic dysfunction by measuring mid-to-apical IVPG as an indicator of the active suction force sucking blood from the left atrium into the LV. We included 38 rTOF patients and 101 healthy controls. The study population was stratified based on age group into children (4–9 years), adolescents (10–15 years), and adults (16–40 years). IVPGs were calculated based on mitral inflow measurements obtained using color M-mode Doppler echocardiography. Although total IVPGs did not differ between rTOF patients and controls, mid-to-apical IVPGs in adolescents and adults were smaller among rTOF patients than among controls (0.15 ± 0.05 vs. 0.21 ± 0.06 mmHg/cm, p < 0.05; 0.09 ± 0.07 vs. 0.17 ± 0.05 mmHg/cm, p < 0.001; respectively). Additionally, only mid-to-apical IVPG correlated linearly with peak circumferential strain (ρ = 0.217, p = 0.011), longitudinal strain (ρ = −0.231, p = 0.006), torsion (ρ = −0.200, p = 0.018), and untwisting rate in early diastole (ρ = −0.233, p = 0.006). In rTOF, the mechanisms underlying diastolic dysfunction involve reduced active suction force, which correlates with reduced LV deformation in all directions.

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Acknowledgements

We thank the staff of Shizuoka Children’s Hospital for collecting the echocardiographic data of children and adults with no cardiac defects (control group).

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Authors and Affiliations

  1. Department of Pediatrics and Adolescent Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Maki Kobayashi, Ken Takahashi, Mariko Yamada, Kana Yazaki & Toshiaki Shimizu

  2. Department of Pediatrics, Juntendo University, Faculty of Medicine, Tokyo, Japan

    Kotoko Matsui, Noboru Tanaka, Sachie Shigemitsu, Katsumi Akimoto & Masahiko Kishiro

  3. Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan

    Keisuke Nakanishi & Shiori Kawasaki

  4. Department of Pediatric Cardiology, Shizuoka Children’s Hospital, Shizuoka, Japan

    Masaki Nii

  5. Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Keiichi Itatani

Authors
  1. Maki Kobayashi
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  2. Ken Takahashi
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  3. Mariko Yamada
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  14. Toshiaki Shimizu
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Contributions

Article drafting, data collection/analysis/interpretation: MK. Study concept/design, critical revision of article, statistical analysis: KT. Data collection/analysis/interpretation: MY, KY, KM, NT, SS, KA. Study concept/design: MK, KN, SK, MN, KI. Critical revision of article: TS.

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Correspondence to Ken Takahashi.

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The authors declare that there is no conflict of interests.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study, or from their legal representatives.

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Kobayashi, M., Takahashi, K., Yamada, M. et al. Assessment of early diastolic intraventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot. Heart Vessels 32, 1364–1374 (2017). https://doi.org/10.1007/s00380-017-1011-6

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  • DOI: https://doi.org/10.1007/s00380-017-1011-6

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