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Echocardiographic predictors of elevated left ventricular end diastolic pressure in adolescent and adult patients with repaired tetralogy of Fallot

Published online by Cambridge University Press:  18 June 2019

Adam M. Lubert Open the ORCID record for Adam M. Lubert [Opens in a new window] ,
Timothy B. Cotts ,
Jeffrey D. Zampi ,
Sunkyung Yu  and
Mark D. Norris
Adam M. Lubert*
Affiliation:
Cincinnati Children’s Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Timothy B. Cotts
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, MI, USA
Jeffrey D. Zampi
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, MI, USA
Sunkyung Yu
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, MI, USA
Mark D. Norris
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Mott Children’s Hospital, Ann Arbor, MI, USA
*
Address for correspondence: Adam M. Lubert, The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA. Tel: 513-803-2243; Fax: 513-803-0079; E-mail: Adam.Lubert@cchmc.org
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Abstract

Elevated left ventricular end diastolic pressure is a risk factor for ventricular arrhythmias in patients with tetralogy of Fallot. The objective of this retrospective study was to identify echocardiographic measures associated with left ventricular end diastolic pressure >12 mmHg in this population. Repaired tetralogy of Fallot patients age ≥13 years, who underwent a left heart catheterisation within 7 days of having an echocardiogram were evaluated. Univariate comparison was made in echocardiographic and clinical variables between patients with left ventricular end diastolic pressure >12 versus ≤12 mmHg. Ninety-four patients (54% male) with a median age of 24.6 years were included. Thirty-four (36%) had left ventricular end diastolic pressure >12 mmHg. Patients with left ventricular end diastolic pressure >12mmHg were older (median 32.9 versus 24.0 years, p = 0.02), more likely to have a history of an aortopulmonary shunt (62% versus 38%, p = 0.03), and have a diagnosis of hypertension (24% versus 7%, p = 0.03) compared to those with left ventricular end diastolic pressure ≤12 mmHg. There were no significant differences in mitral valve E/A ratio, annular e’ velocity, or E/e’ ratio between patients with left ventricular end diastolic pressure >12 versus ≤12 mmHg. Patients with left ventricular end diastolic pressure >12mmHg had larger left atrial area (mean 17.7 versus 14.0 cm2, p = 0.03) and larger left atrium anterior–posterior diameter (mean 36.0 versus 30.6 mm, p = 0.004). In conclusion, typical echocardiographic measures of left ventricular diastolic dysfunction may not be reliable in tetralogy of Fallot patients. Prospective studies with the use of novel echocardiographic measures are needed.

Keywords

Tetralogy of Fallotadult congenital heart diseaseechocardiographydiastolic dysfunction
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 8 , August 2019 , pp. 1020 - 1024
Copyright
© Cambridge University Press 2019 

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