1346439 - Right Ventricular Diastolic Function performance in Children with Repaired Tetralogy of Fallot: A CMR study in Comparison with Transthoracic Echocardiography

Diastolic dysfunction (DD) of repaired TOF (rTOF), which is possibly detected early in the disease course, was considered to be associated with adverse long-term outcomes. Whereas plenty of researches focus on left ventricular, few studies investigated right diastolic function, especially when it refers to pediatric patients. The information about RV diastolic function performance in children with rTOF is sparse. This purpose of this study is to analysis the feasibility of cardiovascular magnetic resonance imaging (CMR) in evaluation the RV diastolic function comparing with transthoracic echocardiography, and to evaluation the RV diastolic function performance in children with rTOF.



Methods:

This study prospectively enrolled the rTOF patients and a group of volunteers who underwent transthoracic Doppler echocardiography and CMR exams on the same day. RV diastolic function was assessed using the following parameters: (1) trans-tricuspid valve (TV) early (E) and late (A) inflow velocities and the E/A ratio; (2) tricuspid annulus (TA) early and late tissue Doppler velocity (TA e’ and a’); (3) TV peak E velocity deceleration time (DurT) and (4) the ratio of E and e’ velocities (E/e’) (Figure 1). The agreement and correlation analysis of RV diastolic function parameters between CMR and TTE were performed. RV DD grading was performed and its agreement with TTE was analyzed. The comparison analysis of RV diastolic function parameters between rTOF and volunteers were performe



Results:

A total of 130 repaired pediatric TOF patients and 35 volunteers were enrolled in this study. E velocity, A velocity, and E/A ratio were lower in CMR than in TTE (all p</span>＜0.05), their correlation between CMR and TTE were strong (correlation coefficient 0.76 to 0.8) and their consistency were very good (ICC 0.86 to 0.89) (Table 1). The mean e’, a’, E/e’ were lower in CMR than in TTE (all p</span>＜0.05) while the lateral a’, E/e’ were comparable between CMR and TTE, except e’ was lower. There was strong correlation of e’ and E/e’ between CMR and TTE with moderate correlation of a’ and their consistency were from good to very good (Table 1). A total of 83 cases (63.8%) present RV DD, and Kappa was 0.55 when it referred to the diastolic grading (Figure 2). Right atrium and ventricle were larger in rTOF patients with e’ and a’ was lower than in controls (Figure 2).

 



Conclusion:

CMR was feasible for discriminating RV DD with good correlation and high reproducibility as compared with TTE. There was a high prevalence of RV DD in children with rTOF. E/e’ is a robust marker for both presence and severity of RV DD.