MRI predictors of diastolic dysfunction and right ventricle end diastolic pressure in repaired tetralogy of Fallot.

We sought to identify cardiac magnetic resonance (CMR) predictors of RV end-diastolic pressure (RVEDP) and diastolic dysfunction in patients with repaired Tetralogy of Fallot (rTOF), by simultaneous analysis of atrial and ventricular volume/time (V/t) curves by CMR. CMR was performed in patients who underwent cardiac catheterization (CC). Parameters of diastolic function were obtained by combined analysis of right and left, atrial and ventricular, V/t curves and respective dV/dT curves. Thirty-five patients with rTOF were included in the study (age 32 ± 16 years) and 9 age-matched control group. Patients with RVEDP ≥12 mmHg presented lower right atrial (RA) ejection fraction (14.8 ± 9 vs 21.3 ± 6%; p = 0.02); lower isovolumetric caval vein transit volume (ICVT) (45 ± 17 vs 64.8 ± 24 ml; p = 0.01); higher RA Atrial-Peak Emptying Rate (PER-A) (-144 [-175; -68] vs -72 [-88; -23] ml/s; p = 0.03) and lower RV Atrial-Peak Filling Rate (PFR-A) (81 [37; 146] vs 176 [126; 236] ml/s; p = 0.005) suggestive of an impaired relaxation of RV. Whereas, left Atrium (LA) volume conduit (6 ± 3 vs 4.8 ± 2.4 ml/m2; p = 0.02) and absolute value of LA PER-E index (-1.8 ± 0.5 vs -1.3 ± 0.5 ml/s; p = 0.006) were higher in these patients, suggesting a greater passive LV filling. At ROC analysis, a combined score including LA volumes and booster peak demonstrated 100% sensitivity and 87% specificity to predict adverse cardiac events in this population at a follow-up time of 8.5 (IQ 4.8; 24) months. In conclusion, the analysis of ventricular and atrial V/T curves showed physio-pathological insights of biventricular dysfunction in rTOF. Moreover, LA diastolic parameters were associated with adverse events in this selected rTOF cohort.