Assessment and Implications of Right Ventricular Afterload in Tetralogy of Fallot

• Published in: The American journal of cardiology 2019-12, Vol.124 (11), p.1780-1784
• Main Authors: Egbe, Alexander C., Taggart, Nathaniel W., Reddy, Yogesh N.V, Sufian, Mahir, Banala, Keerthana, Vojjini, Rahul, Najam, Maria, Osman, Karim, Obokata, Masaru, Borlaug, Barry A.
• Format: Article
• Language: English
• Subjects: Blood pressure; Cardiac Catheterization; Cardiovascular disease; Catheterization; Catheters; Child, Preschool; Clinical outcomes; Confidence intervals; Congenital diseases; Doppler effect; Echocardiography; Echocardiography, Doppler; Electrocardiography; Female; Follow-Up Studies; Forecasting; Heart; Heart transplantation; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Infant; Intubation; Male; Mercury; Prognosis; Pulmonary arteries; Pulmonary artery; Retrospective Studies; Risk analysis; Risk factors; Stroke; Stroke Volume; Systolic pressure; Tetralogy of Fallot; Tetralogy of Fallot - complications; Tetralogy of Fallot - diagnosis; Tetralogy of Fallot - physiopathology; Transplants; Velocity; Ventricle; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology; Ventricular Function, Right - physiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.08.035

Patients with tetralogy of Fallot (TOF) have abnormal right ventricular (RV) afterload because of residual or recurrent outflow tract obstruction, often with abnormal pulmonary artery (PA) vascular function. The purpose of this study was to determine if RV afterload was independently associated with death and/or heart transplant in patients with TOF. This is a retrospective study of TOF patients that underwent cardiac catheterization for clinical indications at Mayo clinic between 1990 and 2015. Invasively measured RV systolic pressure (RVSP) was used to define RV afterload. To explore clinical utility for echocardiographic estimates of invasive data, correlations between invasive and Doppler-derived indices of RV afterload were examined. Among 266 patients with TOF (age 35 ± 14 years, TOF-pulmonary atresia 117 [44%]), RVSP was 72 ± 28 mm Hg, PA systolic pressure 45 ± 19 mm Hg, mean PA pressure 27 ± 10 mm Hg, pulmonary vascular resistance 4.2 ± 3.1 WU, and PA wedge pressure 14 ± 5 mm Hg. Over a mean follow up of 12.9 years, there were 35 deaths and 4 heart transplants. Invasively measured RVSP (hazard ratio 1.25, 95% confidence interval 1.12 to 1.37; p