Key result
Right ventricular-pulmonary artery uncoupling was present in 90 of 135 post-operative Tetralogy of Fallot patients and was associated with significantly reduced right ventricular ejection fraction (40.90% vs 54.63%, p=0.001).
Why the study?
To evaluate RV-PA coupling in postoperative TOF patients with ventricular dilatation undergoing PVR, its correlation with ventricular function, and the effect of primary surgical repair type.
Does pulmonary valve replacement improve right ventricular function and RV-PA coupling in post-operative Tetralogy of Fallot patients with ventricular dilatation?
Observational (n=135)
No
Does pulmonary valve replacement improve right ventricular function and RV-PA coupling in post-operative Tetralogy of Fallot patients with ventricular dilatation?
Absolute Event Rate: 40.9% vs 54.63%
p-value: p=0.001
Pulmonary valve replacement in post-operative Tetralogy of Fallot patients significantly improves right ventricular function and restores favorable RV-PA coupling.
RV-PA uncoupling may flag higher-risk post-op TOF patients; leaves open whether PVR restores coupling.
BACKGROUND: To evaluate RV-PA coupling in post operative TOF patients with ventricular dilatation underwent for PVR and investigate the correlation between ventricular functions measuring Ea/Emax ratio using cardio magnetic resonance and the effect of surgical type at primary repair of TOF on coupling. METHOD: RV-PA coupling was measured noninvasively by Ea/Emax ratio from CMRI and ECHO. From CMRI results the patients were divided in two groups, RV-PA coupling and RV-PA uncoupling. Ea/Emax ≤1 was considered for coupling patients and Ea/Emax > 1 for uncoupling patients. RESULTS: Ninety patients were uncoupled (Ea/Emax: 1.55 ± 0.46) and 45 were coupled (Ea/Emax: 0.81 ± 0.15). Out of 75 TAP repaired patients 60 were uncoupled RV-PV. In addition, higher pro-BNP is an important factor for uncoupled RV-PV (P = 0.001). CMR evaluation for right ventricular function between uncoupling and coupling were RVEDVi (196.65 ± 63.57 vs. 154.28 ± 50.07, P = 0.001), RVESVi (121.19 ± 51.47 vs. 83.94 ± 20.43, P = 0.001), RVSVi (67.19 ± 19.87 vs. 106.31 ± 33.44, P = 0.001), and RVEF (40.90 ± 8.73 vs. 54.63 ± 4.76, P = 0.001). The increased RVEDVi, RVESVi and RVSVi and decreased RVEF have significant correlation with Ea/Emax. Ea/Emax was also found positively correlated with RVEDVi (P = < 0.05, r = 0.35), RVESVi (P = < 0.001, r = 0.41) and negatively correlated with RVSVi (P = < 0.05, r = 0.22) and RVEF (P = < 0.05, r = 0.78). CONCLUSIONS: Unfavorable RV-PA coupling is present in post operative TOF patients and it is affected by several factors. Our results explain a new concept of RV-PA interactions as a contributing mechanism for the observed decline in RV function.
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Sandeep et al. (2020) conducted an observational in Post-operative Tetralogy of Fallot (n=135). Right ventricular-pulmonary artery uncoupling (Ea/Emax > 1) vs. Right ventricular-pulmonary artery coupling (Ea/Emax ≤ 1) was evaluated on Right ventricular ejection fraction (RVEF) (p=0.001). Right ventricular-pulmonary artery uncoupling was present in 90 of 135 post-operative Tetralogy of Fallot patients and was associated with significantly reduced right ventricular ejection fraction (40.90% vs 54.63%, p=0.001).
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