Severe pulmonary regurgitation in adolescents with tetralogy of Fallot leads to increased longitudinal strain

OBJECTIVES: Postoperative patients with tetralogy of Fallot (TOF) are often compromised by chronic pulmonary regurgitation and chronic right ventricular volume load. We sought to determine whether pulmonary regurgitation (PR) would affect right and left ventricle (RV and LV) strain. MATERIALS AND METHODS: This cross-sectional analysis included 40 patients who had TOF with surgical repair, with an average follow-up period of 11.8 ± 3.0 years. Altogether, 44 healthy volunteers with similar age and gender distribution were recruited. A cardiovascular magnetic resonance imaging study with feature tracking analysis was performed on all patients and controls. RESULTS: RV peak longitudinal strain was increased in TOF patients with PR > 30 ml/m(2) when compared to those with PR < 30 ml/m(2) (− 22.5% ± 2.7% vs − 19.7% ± 3.5%, p = 0.018) and controls (p = 0.007). PR volume correlated with peak RV longitudinal strain (R = − 0.37, p = 0.030) and peak RV longitudinal strain rate (systolic: R = 0.37, p = 0.03; diastolic: R = 0.39, p = 0.021). The peak RV circumferential strain, from base to apex, increased more than in healthy controls (apex-base difference 7.6% ± 4.2% vs 3.3% ± 2.4%, p < 0.0001). CONCLUSIONS: Pediatric patients with TOF and a severe pulmonary regurgitation show an enhanced longitudinal strain when compared to patients with milder regurgitation or to control subjects. In addition, mean RV circumferential strain of the patients is significantly enhanced compared to healthy individuals.