Right ventricular longitudinal function is linked to left ventricular filling pressure in patients with repaired tetralogy of fallot

Experimental data on pulmonary regurgitation has linked right ventricular longitudinal function to left ventricular filling pressure in animals with induced and treated pulmonary regurgitation but this relationship has not been investigated in patients with repaired Tetralogy of Fallot (rToF). The aim of this study was to determine if right ventricular longitudinal function assessed using cardiovascular magnetic resonance (CMR) is associated with left ventricular filling pressure in patients with rToF. A second objective of this study was to determine if direction of septal movement is related to right ventricular pressure load in rToF. Eighteen patients with rToF undergoing CMR and heart catheterization prior to pulmonary valve replacement were retrospectively included and catheter-based pressure measurements were compared with CMR-derived RV regional function. Left ventricular filling pressure was measured as precapillary wedge pressure (PCWP). Longitudinal contribution to RV stroke volume correlated with PCWP (r =0.48; p = 0.046) but not with RV EF or pulmonary regurgitation. Neither RV longitudinal strain nor TAPSE showed correlation with PCWP. Longitudinal contribution to stroke volume was lower for the RV compared to the LV (49 vs 54%; p =0.039). Direction of septal movement did not show a correlation with RV endsystolic pressure. Right ventricular longitudinal pumping is associated with left ventricular filling pressure in rToF-patients and this inter-ventricular coupling may explain LV underfilling in patients with pulmonary regurgitation and rToF and may be of value to determine right ventricular dysfunction. RV systolic pressure, however, cannot be assessed from the direction of septal movement, in these patients.

Automated summary

This study aimed to investigate the relationship between right ventricular longitudinal function assessed by cardiovascular magnetic resonance (CMR) and left ventricular filling pressure in patients with repaired Tetralogy of Fallot (rToF). The study found that there is an association between right ventricular longitudinal pumping and left ventricular filling pressure in rToF-patients, which may explain the underfilling of the left ventricle in patients with pulmonary regurgitation and rToF, and may be useful in determining right ventricular dysfunction. However, the direction of septal movement cannot be used to assess right ventricular systolic pressure in these patients.