Diastolic dysfunction in tetralogy of Fallot: Comparison of echocardiography with catheterization

Abstract

Background

Right ventricular (RV) systolic dysfunction has been associated with adverse outcomes in tetralogy of Fallot (TOF). However, the role and etiology of diastolic dysfunction remains incompletely defined. We sought to assess the association between traditional echocardiographic measures of diastolic function with catheter-based RV end-diastolic pressure (RVEDP) and identify clinical characteristics independently associated with diastolic dysfunction.

Methods

Single-center, retrospective cohort study of surgically repaired TOF patients undergoing cardiac catheterization with echocardiograms within three months prior to catheterization. Tricuspid inflow and tissue Doppler measurements (E/A, E/e′, and deceleration time) defined diastolic dysfunction, graded as impaired relaxation, pseudonormal or restrictive physiology. Regression analyses tested associations between echocardiographic parameters, RVEDP, and clinical characteristics.

Results

Ninety-four subjects were included. Age at catheterization was 8.9 years (Interquartile range 4.4, 15.9). RVEDP was 9.5±2.5 mm Hg. Sixty-one (65%) subjects had echocardiographic evidence of diastolic dysfunction. RVEDP was not associated with any echocardiographic parameter of diastolic function (grade of dysfunction, E/e′, or E/A). Higher RVEDP was associated with larger right atrial and RV end-diastolic area, independently of weight and degree of pulmonary or tricuspid regurgitation, though was not associated with indexed right atrial or RV end-diastolic area. Greater number of interim procedures was associated with higher RVEDP, E/e′, and presence of diastolic dysfunction by echocardiography.

Conclusions

Diastolic dysfunction, as determined by echocardiography-derived and catheter-based (RVEDP) measures, is prevalent in this population of TOF. These measures are not associated with each other, therefore echocardiographic parameters of diastolic function are not reflective of RVEDP. Development of noninvasive parameters that are associated with filling pressures is required.