Key result
Higher right atrial volume index is linked to adverse outcomes after pulmonary valve replacement.
Why the study?
The optimal timing of pulmonary valve replacement in repaired tetralogy of Fallot remains debated.
Does right ventricular diastolic dysfunction predict adverse outcomes after pulmonary valve replacement in patients with repaired tetralogy of Fallot?
Cohort (n=81)
No
Does right ventricular diastolic dysfunction predict adverse outcomes after pulmonary valve replacement in patients with repaired tetralogy of Fallot?
Hazard Ratio: 1.01 (95% CI 1–1.03)
p-value: p=0.0075
Right ventricular diastolic dysfunction, specifically indicated by increased right atrial volume index, is a significant predictor of adverse clinical outcomes after pulmonary valve replacement in patients with repaired tetralogy of Fallot.
Right atrial volume index may refine post-PVR risk stratification in repaired tetralogy of Fallot; leaves open the interaction with right ventricular diastolic dysfunction and age.
Background: The optimal timing of pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (TOF) remains debated. We examined the influence of right ventricular (RV) diastolic dysfunction on post-PVR outcomes and investigated whether age ≥35 years at PVR is universally associated with adverse outcomes or represents a risk factor only in specific patient subgroups. Methods and Results: . Cox regression analysis was used to identify factors associated with adverse outcomes, with subgroup analyses stratified by the presence or absence of RV diastolic dysfunction. Adverse outcomes occurred in 24 patients (30%). The RA volume index was the only independently significant predictor of adverse outcomes. Age ≥35 years at PVR was significantly associated with reduced freedom from adverse events, but only in patients with RV diastolic dysfunction. Conclusions: RV diastolic dysfunction was significantly associated with post-PVR clinical outcomes. Age ≥35 years at PVR was a significant risk factor only in patients with RV diastolic dysfunction, but not in those without, suggesting that advanced age alone does not uniformly confer increased risk.
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Kido et al. (2026) conducted a cohort in Repaired tetralogy of Fallot (n=81). Right atrial volume index vs. Lower right atrial volume index was evaluated on Adverse outcomes (catheter ablation or pacemaker implantation for arrhythmia, or unplanned hospitalization for heart failure) (HR 1.01, 95% CI 1.00-1.03, p=0.0075). Right atrial volume index was an independent predictor of adverse outcomes after pulmonary valve replacement (HR 1.01), and age ≥35 years increased risk only in patients with right ventricular diastolic dysfunction.
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