Key result
Higher RACI is linked to high-risk Importance Factor Scores in repaired tetralogy of Fallot.
Why the study?
Atrial size and function reflect diastolic function, which predicts adverse outcomes in rTOF, prompting investigation into whether automated atrial CMR measures can predict risk in these patients.
Does the Right Atrioventricular Coupling Index (RACI) measured by CMR predict a high-risk Importance Factor Score in patients with repaired tetralogy of Fallot?
Observational (n=63)
No
Does the Right Atrioventricular Coupling Index (RACI) measured by CMR predict a high-risk Importance Factor Score in patients with repaired tetralogy of Fallot?
Effect estimate: AUC 0.73
Absolute Event Rate: 18.6% vs 13.5%
p-value: p=0.03
The novel Right Atrioventricular Coupling Index (RACI) derived from automated CMR measurements can serve as a noninvasive predictor of high-risk status for life-threatening arrhythmias in patients with repaired tetralogy of Fallot.
RACI may aid noninvasive risk assessment in repaired tetralogy of Fallot; hypothesis-generating and requires prospective validation before adoption.
Atrial size and function have been recognized as markers of diastolic function, and diastolic dysfunction has been identified as a predictor of adverse outcomes in repaired tetralogy of Fallot (rTOF). This was a retrospective single-center study with the objective of investigating the use of atrial measurements obtained via CMR for predicting outcomes in rTOF patients. Automated contours of the left and right atria (LA and RA) were performed. A novel parameter, termed the Right Atrioventricular Coupling Index (RACI), was defined as the ratio of RA end-diastolic volume to right ventricle (RV) end-diastolic volume. Patients were risk-stratified using a previously validated Importance Factor Score for the prediction of life-threatening arrhythmias in rTOF. Patients with a high-risk Importance Factor Score (>2) had a significantly larger minimum RA volume (p = 0.04) and RACI (p = 0.03) compared to those with scores ≤2. ROC analysis demonstrated RACI to be the best overall predictor of a high-risk Importance Factor Score (AUC 0.73, p = 0.03). Older age at the time of repair and a diagnosis of pulmonary atresia were associated with a larger RACI. Automated atrial CMR measurements are easily obtained from standard CMRs and have the potential to serve as noninvasive predictors of adverse outcomes in rTOF.
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Gunsaulus et al. (2023) conducted an observational in Repaired tetralogy of Fallot (rTOF) (n=63). Right Atrioventricular Coupling Index (RACI) vs. Low-risk Importance Factor Score (≤2) was evaluated on High-risk Importance Factor Score (>2) (AUC 0.73, p=0.03). A higher Right Atrioventricular Coupling Index (RACI) was an effective predictor of a high-risk Importance Factor Score in repaired tetralogy of Fallot patients (AUC 0.73, p=0.03).
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