Utility of Doppler Echocardiography to Estimate the Severity of Pulmonary Valve Regurgitation Fraction in Patients with Repaired Tetralogy of Fallot
In patients with repaired Tetralogy of Fallot (rTOF), pulmonary regurgitation (PR) leads to significant morbidity. Cardiac magnetic resonance imaging (CMR) is the gold standard to assess severity of PR in rTOF patients. We compared Doppler echocardiography derived indices of PR with CMR to find the best predictive parameter for hemodynamically significant (hs) PR.
This is a retrospective analysis of echocardiogram and CMR measurements. Doppler indices obtained included: PR deceleration slope, pressure half time (PHT) and PR index. Receiver operating characteristic curve analysis was used to optimize the sensitivity and specificity of selected variables in predicting hsPR. Inter-observer variability of the Doppler parameters was assessed in a random sample of 25 Doppler spectral recordings.
Our cohort (n = 96) comprised of 52 (54.2%) males. The mean (SD) age at CMR was 22.9 (10.3) years. 83.4% patients underwent complete repair with transannular patch. 78 (81%) patients had hsPR as defined by CMR PR > 20%. Doppler parameters with the values of; PR index of < 0.86, PR deceleration slope of > 375 cm/s2 and a PHT < 130 ms, demonstrated high sensitivity (93%) and high negative predictive values (98–99%). All the Doppler indices demonstrated minimal inter-observer variability (PHT = 0.9, 95% CI 0.69–0.97; PRi = 0.95, 95%CI 0.83–0.98).
Our data, with its high negative predictive values, show that Doppler derived echocardiography indices have an ability to rule out hsPR, as measured by CMR. PHT, PR index and deceleration slope correlate with hsPR and can be used as screening tools for further testing.
KeywordsTetralogy of Fallot Pulmonary regurgitation Cardiac magnetic resonance Doppler echocardiography
Compliance with Ethical Standards
Conflict of interest
All the authors have no conflicts of interest.
This is a retrospective study and the need for Informed consent was waived by the Institutional Review Board.
Research Involving Human and Animal Participants
This article does not contain any studies with human participants performed by any of the authors.
- 14.Rominger MB, Bachmann GF, Pabst W, Rau WS (1999) Right ventricular volumes and ejection fraction with fast cine MR imaging in breath-hold technique: applicability, normal values from 52 volunteers, and evaluation of 325 adult cardiac patients. J Magn Reson Imaging 10(6):908–918CrossRefGoogle Scholar
- 16.Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al (2008) ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52(23):e143–e263CrossRefGoogle Scholar
- 18.Mercer-Rosa L, Yang W, Kutty S, Rychik J, Fogel M, Goldmuntz E (2012) Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot: a comparative analysis of echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging 5(5):637–643CrossRefGoogle Scholar