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Right atrial function early after tetralogy of Fallot repair

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Abstract

Diastolic dysfunction after repair for Tetralogy of Fallot (TOF) is associated with adverse long-term outcomes. Right atrial (RA) mechanics as a proxy of right ventricular (RV) diastolic function in the early post-operative period after surgical repair for TOF has not been reported. We sought to evaluate RA and RV strain prior to hospital discharge after TOF repair and to identify important patient factors associated with strain using a machine learning method. Single center retrospective cohort study of TOF patients undergoing surgical repair, with analysis of RA and RV strain from pre-and post-operative echocardiograms. RA function was assessed by the peak RA strain, systolic RA strain rate, early diastolic RA strain rate and RA emptying fraction. RV systolic function was measured by global longitudinal strain. Pre- and post-operative values were compared using Wilcoxon rank sum test. Gradient boosted machine (GBM) models were used to identify the most important predictors of post-operative strain. In total, 153 patients were enrolled, median age at TOF repair 3.5 months (25th-75th percentile: 2.2- 5.2), mostly male (67%), and White (64.1%). From pre-to post-operative period, there was significant worsening in all RA parameters and in RV strain. GBM models identified patient, anatomic, and surgical factors that were strong predictors of post-operative RA and RV strain. These factors included pulmonary valve and branch pulmonary artery Z scores, birth weight, gestational age and age at surgery, pre-operative RV fractional area change and oxygen saturation, type of outflow tract repair, duration of cardiopulmonary bypass, and early post-operative partial arterial pressure of oxygen. There is significant worsening in RA and RV strain early after TOF repair, indicating early alteration in diastolic and systolic function after surgery. Several patient and operative factors influence post-operative RV function. Most of the factors described are not readily modifiable, however they may inform pre-operative risk-stratification. The clinical application of RA strain and the prognostic implication of these early changes merit further study.

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Abbreviations

RA:

Right atrium/ right atrial

RV:

Right ventricle/ right ventricular

GBM:

Gradient boosted quantile regression models

TOF:

Tetralogy of Fallot

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Funding

This work was supported by Grant NIH K01HL125521 (Mercer-Rosa), and Pulmonary Hypertension Association Supplement to K01HL125521.

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Author notes

  1. Laura Mercer-Rosa

    Present address: Division of Cardiology, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA

Authors and Affiliations

  1. Division of Cardiology, Rush University Children’s Hospital, Chicago, IL, USA

    Omonigho Ekhomu

  2. Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jennifer A. Faerber & Jing Huang

  3. Division of Cardiology, Echocardiography Laboratory, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Yan Wang & Anh Duc Mai

  4. Division of Cardiology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, NY, USA

    Michael P. DiLorenzo

  5. Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Shivani M. Bhatt, Catherine M. Avitabile & Laura Mercer-Rosa

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  1. Omonigho Ekhomu
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  2. Jennifer A. Faerber
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Contributions

All authors contributed to the study conception and design. The authors would like to thank Sharon Edman, MS, for data management. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Laura Mercer-Rosa.

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Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study protocol was approved by the Institutional Review Board for the Protection of Human Subjects at Children’s Hospital of Philadelphia, and parents of subjects gave informed consent to participating in the study.

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Ekhomu, O., Faerber, J.A., Wang, Y. et al. Right atrial function early after tetralogy of Fallot repair. Int J Cardiovasc Imaging 38, 1961–1972 (2022). https://doi.org/10.1007/s10554-022-02595-y

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