Key result
Adults after tetralogy of Fallot repair exhibited lower global peak circumferential ascending aortic strain (6.0% vs 8.1%, P=0.01) and higher aortic stiffness compared to normal controls.
Why the study?
Does CAAS derived from 2D-STE detect increased ascending aortic stiffness in adults after tetralogy of Fallot repair compared to normal controls?
Case-Control (n=123)
Does CAAS derived from 2D-STE detect increased ascending aortic stiffness in adults after tetralogy of Fallot repair compared to normal controls?
Absolute Event Rate: 6% vs 8.1%
p-value: p=0.01
CAAS derived from 2D-STE provides a noninvasive method to assess ascending aortic stiffness in adults after tetralogy of Fallot repair, demonstrating increased stiffness compared to controls.
May warrant aortic surveillance in repaired tetralogy of Fallot; leaves open prognostic implications.
BACKGROUND: Late after tetralogy of Fallot (TOF) repair some patients exhibit aortic dilatation and stiffness. Noninvasive assessment of aortic stiffness could contribute to understand this aortopathy and may be important in risk stratification for major aortic event. METHODS: We included prospectively 82 adults after TOF repair and 41 age- and sex-matched normal controls. Aortic diameters were measured by two-dimensional transthoracic echocardiography and the aortic z-score was estimated. Aortic deformation was assessed by M-mode strain and global peak circumferential ascending aortic strain (CAAS), derived from two-dimensional speckle tracking echocardiography (2D-STE). Corrected CAAS was calculated as CAAS/pulse pressure. Ascending aorta (AAo) distensibility and stiffness index were calculated. RESULTS: , P < .01), higher aortic stiffness index (9.5 [2.7-98.4] vs 7.1 [2.3-20.4], P = .02) and lower CAAS (6.0 ± 3.9 vs 8.1 ± 4.4%, P = .01) compared to controls. CAAS showed a better correlation with AAo z-score (r = -.25, P = .03) compared to M-mode strain. Systemic arterial compliance, arterial stiffness and corrected CAAS (β = -0.23, P = .02) were independently associated with AAo diameter. CONCLUSIONS: TOF patients have a larger and stiffer AAo compared to controls. CAAS derived from 2D-STE allows a routine noninvasive method for assessing AAo stiffness, with advantages over M-mode strain, and may be used as predictor of major aortic or cardiovascular events.
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Cruz et al. (2018) conducted a case-control in Tetralogy of Fallot (n=123). Tetralogy of Fallot vs. Normal controls was evaluated on Global peak circumferential ascending aortic strain (CAAS) (p=0.01). Adults after tetralogy of Fallot repair exhibited lower global peak circumferential ascending aortic strain (6.0% vs 8.1%, P=0.01) and higher aortic stiffness compared to normal controls.
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