Key result
In patients with repaired tetralogy of Fallot, the presence of end-diastolic forward flow was associated with impaired biventricular diastolic reserve, evidenced by a significantly greater augmentation of left ventricular end-diastolic pressure after contrast injection.
Why the study?
It was hypothesized that end-diastolic forward flow in repaired tetralogy of Fallot is modified by left ventricular hemodynamics, rather than limited to right ventricular diastolic stiffening.
Does the presence of end-diastolic forward flow (EDFF) reflect left ventricular hemodynamic changes and end-organ damage in patients with repaired tetralogy of Fallot?
Observational (n=122)
No
Does the presence of end-diastolic forward flow (EDFF) reflect left ventricular hemodynamic changes and end-organ damage in patients with repaired tetralogy of Fallot?
In patients with repaired tetralogy of Fallot, end-diastolic forward flow reflects not only right ventricular diastolic dysfunction but is also significantly affected by left ventricular hemodynamics and associated with end-organ damage.
EDFF signals LV-influenced RV diastolic dysfunction and stagnation in repaired TOF; leaves open whether it guides biventricular assessment.
BACKGROUND: Although right ventricular (RV) enlargement may affect RV diastolic dysfunction assessed by end-diastolic forward flow (EDFF) in patients with repaired tetralogy of Fallot (TOF), EDFF may also be modified by left ventricular (LV) hemodynamics. We hypothesized that EDFF is affected by LV hemodynamics, not limited to RV diastolic stiffening. METHODS AND RESULTS: Among 145 consecutive patients with repaired TOF who underwent catheterization, hemodynamic properties in 47 with consistent EDFF and 75 without EDFF were analyzed. Compared with patients without EDFF, those with EDFF had a large RV volume with a high regurgitant fraction. Although cardiac index and central venous pressure (CVP) were similar, contrast injection augmented CVP and LV end-diastolic pressure (EDP) in patients with vs. those without EDFF, suggesting compromised diastolic reserve. In patients with EDFF, the velocity-time integral (VTI) of EDFF was positively correlated with LVEDP and systemic vascular resistance, in addition to RV EDP. EDFF-VTI was correlated with hepatic venous wedge pressure and markers of hepatic dysfunction. Subanalysis of the older (≥6 years) half of the study cohort revealed that EDFF was associated with bi-atrial enlargement independent of RV volume, highlighting the pronounced role of EDFF on the diastolic property in the aged cohort. CONCLUSIONS: EDFF-VTI in patients with repaired TOF reflects RV diastolic dysfunction, affected by the left heart system. EDFF-VTI indicates blood stagnation, which may be attributed to end-organ damage.
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Takahashi et al. (2023) conducted an observational in Repaired Tetralogy of Fallot (n=122). End-diastolic forward flow (EDFF) vs. Absence of end-diastolic forward flow was evaluated on Left ventricular end-diastolic pressure (LVEDP) augmentation after contrast injection (mmHg) (p=<0.01). In patients with repaired tetralogy of Fallot, the presence of end-diastolic forward flow was associated with impaired biventricular diastolic reserve, evidenced by a significantly greater augmentation of left ventricular end-diastolic pressure after contrast injection.
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