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May 22, 2010AJP Heart and Circulatory PhysiologyOpen Access

In patients with surgically repaired tetralogy of Fallot, right atrial cyclic volume change was significantly reduced compared to healthy controls (21.1 vs 34.9 ml/m2), indicating impaired right atrial function.

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Why the study?

Does surgically repaired tetralogy of Fallot with residual pulmonary insufficiency impair right atrial function and atrioventricular interaction compared to healthy controls?

Population

20 asymptomatic patients with surgically repaired tetralogy of Fallot without additional cardiac…

Comparison

Surgically repaired tetralogy of Fallot with… vs Healthy controls without cardiac medical history.

Design

Case-control

Key result

In patients with surgically repaired tetralogy of Fallot, right atrial cyclic volume change was significantly reduced compared to healthy controls (21.1 vs 34.9 ml/m2), indicating impaired right atrial function.

Authors

EREugénie RiesenkampffLMLena MengelkampMMMatthias Mueller

Discussion

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Member takes

Overview

Impaired right atrial function may warrant closer monitoring in repaired tetralogy of Fallot; leaves open effects on atrioventricular interaction and outcomes.

Study Design

Type

Cross-Sectional (n=27)

Multicenter

No

Structured PICO

Does surgically repaired tetralogy of Fallot with residual pulmonary insufficiency impair right atrial function and atrioventricular interaction compared to healthy controls?

P
Population
20 asymptomatic patients (NYHA class I, mean age 19.5 ± 8.9 years, 8 men/12 women, all Caucasian) with surgically repaired tetralogy of Fallot (TOF) without additional cardiac malformations, and 7 healthy controls (mean age 24.6 ± 8.7 years, 4 men/3 women). Key exclusions: mitral or aortic valve insufficiency, tricuspid valve insufficiency greater than grade I, and severe stenosis of the pulmonary outflow.
I
Intervention
Surgically repaired tetralogy of Fallot with residual pulmonary insufficiency (observational exposure).
C
Comparator
Healthy controls without cardiac medical history.
O
Outcome
Atrial and ventricular function and atrioventricular interaction, including atrial reservoir, conduit and pump function, and cyclic volume change measured by cine MRI and echocardiographic speckle tracking.surrogate

Main Result

Absolute Event Rate: 21.1% vs 34.9%

p-value: p=<0.0001

In patients with repaired tetralogy of Fallot, moderate right ventricular dysfunction is associated with significantly impaired right atrial reservoir and pump function.

Limitations

  • Study was conducted in preselected TOF patients with a homogeneous moderate degree of RV enlargement and dysfunction, limiting generalizability.
  • Patients with major tricuspid insufficiency were excluded.
  • Natriuretic peptides were not measured.
  • Cannot fully determine whether the observed abnormalities of RA function are from intrinsic causes (e.g., surgical scar) or express the functional response to abnormal RV function.
  • Atrial pressure was not measured noninvasively, so atrial compliance could not be determined directly.
  • Small sample size (20 patients, 7 controls).

Cite This Study

Riesenkampff et al. (2010) conducted a cross-sectional in Tetralogy of Fallot (n=27). Surgically repaired tetralogy of Fallot vs. Healthy controls was evaluated on Right atrial cyclic volume change (ml/m2) (p=<0.0001). In patients with surgically repaired tetralogy of Fallot, right atrial cyclic volume change was significantly reduced compared to healthy controls (21.1 vs 34.9 ml/m2), indicating impaired right atrial function.

synapsesocial.com/papers/6a154280b2e0231f15822da4https://doi.org/10.1152/ajpheart.00264.2010
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