Ratio of Early Diastolic Tricuspid Inflow to Tricuspid Lateral Annulus Velocity Reflects Pulmonary Regurgitation Severity but Not Right Ventricular Diastolic Function in Children With Repaired Tetralogy of Fallot

Abstract

The current study assessed relationships between the ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity (tricuspid E/e') and right ventricular (RV) function in children after tetralogy of Fallot (TOF) repair. The RV function of 25 asymptomatic children with surgically repaired TOF (age 3.3 ± 2.0 years) was assessed by echocardiography and cardiac catheterization. Right ventricular end-diastolic pressure and volume (RVEDP and RVEDV), systolic pressure, and ejection fraction, as well as mean pulmonary arterial pressure, mean right atrial pressure (RAP), and the severity of both pulmonary regurgitation (PR) and tricuspid regurgitation (TR) were assessed in terms of the contribution to tricuspid E/e'. Univariate analysis discovered a relationship between tricuspid E/e' and RVEDV (R(2) = 0172), pressure half-time of PR (PR-PHT) (R(2) = 0.173), and TR grade (R(2) = 0.145) (p < 0.01 for each). After multivariate adjustment, PR-PHT was significantly associated with tricuspid E/e' (β = 0.210; p < 0.001). Tricuspid E/e' was not significantly associated with RVEDP or RAP. In conclusion, tricuspid E/e' does not indicate RV diastolic function but reflects the severity of PR in asymptomatic children after TOF repair.

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

“…However, our findings are similar to prior studies in patients with TOF, which have shown no association between E/e′ and RV filling pressures in both pediatric and adult populations . One explanation for this finding could be the use of adult guidelines, which may not be reflective of the age‐related variation in echocardiographic parameters.…”

“…Prior studies in adults without congenital heart disease have shown modest to excellent correlation between right atrial pressures and tricuspid valve E/A and E/e′ in varied populations,[5][6][7]18 as well as associations between echocardiographic parameters and improved clinical status in response to therapy in patients with pulmonary hypertension and subclinical hypothyroidism 19,20. These findings would suggest that tricuspid inflow and tissue Doppler parameters are valid measures of RV filling pressures.However, our findings are similar to prior studies in patients with TOF, which have shown no association between E/e′ and RV filling pressures in both pediatric and adult populations 12,21. One explanation for this finding could be the use of adult guidelines, which may not be reflective of the age-related variation in echocardiographic parameters.…”

“…[5][6][7] While echocardiographic measures of RV diastolic function have established normal values in children, [8][9][10] these measures have not been validated, and few studies have evaluated these measures in patients with TOF. 11,12 Although studies in children and adults with TOF have demonstrated an association between diastolic dysfunction and important markers of disease severity, such as exercise intolerance and arrhythmias, 11,[13][14][15][16][17] little is known about diastolic dysfunction in midterm follow-up, and whether clinical factors such as neonatal TOF repair (<1 month of age), type of TOF anatomy, or surgical repair could influence diastolic function in the long term. The goals of this study were to determine the association of echocardiographic measures of diastolic function with catheter-based RV end-diastolic pressure (RVEDP) and to define clinical characteristics associated with diastolic dysfunction and elevated filling pressures.…”

Echocardiographic Parameters of Right Ventricular Diastolic Function in Repaired Tetralogy of Fallot Are Associated with Important Findings on Magnetic Resonance Imaging

“…Previous reports that have described diastolic dysfunction in patients with repaired TOF have reported lower tricuspid annular e′ values and higher E/e′ ratios compared with our population. 8,28 This difference may be due to differences in operative technique or regional comorbidities. Conversely, the incidence of restrictive right ventricular physiology was similar in our cohort compared with other studies.…”

Ocena funkcji prawej komory serca za pomocą dopplera tkankowego oraz metody śledzenia markerów akustycznych

“…E’/A’ and E/E’ ratios are measured for an assessment of right ventricular diastolic function. An early diastolic tricuspid inflow assessed using standard echocardiography technique is designated as E. Studies in adults have shown that increased E/E’ ratio is closely associated with right ventricular filling pressure ( 12 ) , however, this relationship has not been confirmed in pediatric patients after teratology of Fallot repair ( 13 ) .…”