Key result
TPVI is linked to improved LV torsion by ~0.36 degrees/cm at 12 months despite unchanged LVEF.
Why the study?
The impact of transcatheter pulmonary valve implantation on left ventricular function after repair of tetralogy of Fallot and pulmonary regurgitation remains unclear, particularly regarding sensitive indicators like LV torsion.
Does transcatheter pulmonary valve implantation improve left ventricular torsion in patients with pulmonary regurgitation following congenital heart disease repair?
Observational (n=30)
No
Does transcatheter pulmonary valve implantation improve left ventricular torsion in patients with pulmonary regurgitation following congenital heart disease repair?
Absolute Event Rate: 1.18% vs 0.82%
p-value: p=0.0004
Transcatheter pulmonary valve implantation in patients with repaired tetralogy of Fallot and pulmonary regurgitation improves left ventricular torsion despite unchanged ejection fraction, highlighting reverse remodeling and interventricular interaction.
Supports torsion as sensitive marker of LV recovery post-TPVI despite stable LVEF; hypothesis-generating for prognostic value and management impact.
Background: After tetralogy of Fallot (TOF) repair, pulmonary regurgitation (PR) frequently leads to right ventricular (RV) dilation and heart failure. Transcatheter pulmonary valve implantation (TPVI) reduces RV volume, but its impact on left ventricular (LV) function remains unclear. We hypothesized that LV torsion is a more sensitive indicator than LV ejection fraction (LVEF) and evaluated longitudinal changes in torsion using 3D cardiac cine magnetic resonance imaging (MRI) before and after TPVI. Methods and Results: 30 patients with PR (25 with TOF, 4 with pulmonary artery stenosis, and 1 with double-outlet right ventricle; mean age, 42 years) underwent MRI before, 3 months, and 12 months after TPVI. LV time–torsion curves were derived from short-axis cine images using feature-tracking analysis. Torsion, biventricular function, and the PR fraction (PRF) were assessed. Torsion increased progressively (0.82±0.42 vs. 0.98±0.48 vs. 1.18±0.55 degrees/cm; all P<0.01), whereas LVEF showed no significant change (52.1±11.0% vs. 53.7±9.3% vs. 55.3±9.9%). RV end-diastolic volume index and PRF were significantly reduced at 12 months. Conclusions: Despite unchanged LVEF, torsion improved after TPVI, reflecting LVEF-independent LV pump function and interventricular interaction.
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Inoue et al. (2026) conducted an observational in Pulmonary Regurgitation (n=30). Transcatheter pulmonary valve implantation vs. Baseline (Before TPVI) was evaluated on Left ventricular torsion (p=0.0004). Transcatheter pulmonary valve implantation significantly improved left ventricular torsion from 0.82 to 1.18 degrees/cm at 12 months (P=0.0004), despite unchanged left ventricular ejection fraction.
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