Key result
Patients with repaired tetralogy of Fallot demonstrated significantly smaller peak myocardial velocities in both ventricles and higher global left ventricular native T1 compared to healthy volunteers.
Why the study?
In repaired tetralogy of Fallot, RV fibrosis is associated with ventricular tachycardia, heart failure, and sudden death, prompting investigation into links between diffuse fibrosis and regional mechanical dysfunction by CMR.
Does CMR with T1 mapping and tissue phase mapping detect early structural and functional myocardial alterations in patients with repaired tetralogy of Fallot compared to healthy volunteers?
Observational (n=62)
No
Does CMR with T1 mapping and tissue phase mapping detect early structural and functional myocardial alterations in patients with repaired tetralogy of Fallot compared to healthy volunteers?
Absolute Event Rate: -0.9% vs -3%
p-value: p=<0.001
CMR with tissue phase mapping and T1 mapping can detect early impaired systolic and diastolic myocardial function and diffuse fibrosis in patients with repaired tetralogy of Fallot.
May detect early myocardial fibrosis and biventricular dysfunction in rTOF via CMR; leaves open prognostic and therapeutic implications.
In patients with repaired tetralogy of Fallot (rTOF), right ventricular (RV) fibrosis has been associated with ventricular tachycardia, heart failure, and sudden cardiac death. Here, we aimed to identify links between diffuse myocardial fibrosis and regional mechanical dysfunction by cardiac magnetic resonance imaging (CMR) in rTOF. Clinical CMR was extended in 17 consecutive rTOF patients (median age 20 years, 4 females) to include biventricular native T1 (nT1) mapping as indicator of diffuse fibrosis, and tissue phase mapping (TPM) for quantification of biventricular segmental, directional systolic/diastolic myocardial velocities. Patients demonstrated smaller peak velocities than healthy volunteers in both ventricles (e.g. LV-base circumferential peak-systolic velocity: median [IQR] −0.9 [1.5] vs. −3.0 [1.2] cm/s, p < 0.001). RV peak velocities were reduced even in patients with normal RV ejection fraction (e.g. RV-mid long-axis peak-diastolic velocity: −3.3 [1.2] vs. −6.9 [1.8] cm/s, p = 0.001). Global LV nT1 was higher in patients versus controls (1029 [48] vs. 993 [28] ms, p = 0.013). Within the rTOF group, fibrosis in lateral LV correlated with shorter time-to-peak-velocity (TTP), whereas fibrosis in inferior RV correlated with longer TTP. Therefore, in rTOF TPM facilitates early diagnosis of impaired systolic and diastolic myocardial function while diffuse fibrosis has differential effects on RV and LV mechanics.
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Kappler et al. (2026) conducted an observational in Repaired tetralogy of Fallot (n=62). Tissue phase mapping and native T1 mapping vs. Healthy volunteers was evaluated on LV-base circumferential peak-systolic velocity (cm/s) (p=<0.001). Patients with repaired tetralogy of Fallot demonstrated significantly smaller peak myocardial velocities in both ventricles and higher global left ventricular native T1 compared to healthy volunteers.
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