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Atrioventricular Area Difference Aids Diastolic Filling in Patients with Repaired Tetralogy of Fallot

Johansson, Martin LU ; Hedström, Erik LU orcid ; Steding-Ehrenborg, Katarina LU ; Bhat, Misha LU orcid ; Liuba, Petru LU ; Arheden, Håkan LU and Sjöberg, Pia LU (2024) In Pediatric Cardiology
Abstract

A hydraulic force aids diastolic filling of the left ventricle (LV) and is proportional to the difference in short-axis area between the left ventricle and atrium; the atrioventricular area difference (AVAD). Patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) have reduced LV filling which could lead to a negative AVAD and a hydraulic force impeding diastolic filling. The aim was to assess AVAD and to determine whether the hydraulic force aids or impedes diastolic filling in patients with rToF and PR, compared to controls. Twelve children with rToF (11.5 [9–13] years), 12 pediatric controls (10.5 [9–13] years), 12 adults with rToF (21.5 [19–27] years) and 12 adult controls (24 [21–29] years) were... (More)

A hydraulic force aids diastolic filling of the left ventricle (LV) and is proportional to the difference in short-axis area between the left ventricle and atrium; the atrioventricular area difference (AVAD). Patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) have reduced LV filling which could lead to a negative AVAD and a hydraulic force impeding diastolic filling. The aim was to assess AVAD and to determine whether the hydraulic force aids or impedes diastolic filling in patients with rToF and PR, compared to controls. Twelve children with rToF (11.5 [9–13] years), 12 pediatric controls (10.5 [9–13] years), 12 adults with rToF (21.5 [19–27] years) and 12 adult controls (24 [21–29] years) were retrospectively included. Cine short-axis images were acquired using cardiac magnetic resonance imaging. Atrioventricular area difference was calculated as the largest left ventricular short-axis area minus the largest left atrial short-axis area at beginning of diastole and end diastole and indexed to height (AVADi). Children and adults with rToF and PR had higher AVADi (0.3 cm2/m [− 1.3 to 0.8] and − 0.6 [− 1.5 to − 0.2]) at beginning of diastole compared to controls (− 2.7 cm2/m [− 4.9 to − 1.7], p = 0.015) and − 3.3 cm2/m [− 3.8 to − 2.8], p = 0.017). At end diastole AVADi did not differ between patients and controls. Children and adults with rToF and pulmonary regurgitation have an atrioventricular area difference that do not differ from controls and thus a net hydraulic force that contributes to left ventricular diastolic filling, despite a small underfilled left ventricle due to pulmonary regurgitation.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Cardiac magnetic resonance (CMR), Congenital heart defect (CHD), Diastolic function, Hydraulic force, Physiology, Tetralogy of Fallot
in
Pediatric Cardiology
publisher
Springer
external identifiers
  • pmid:38806793
  • scopus:85194552600
ISSN
0172-0643
DOI
10.1007/s00246-024-03508-7
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2024.
id
503876eb-5f52-4d1d-baca-dcbb153cec10
date added to LUP
2024-07-13 09:46:36
date last changed
2024-09-07 15:30:10
@article{503876eb-5f52-4d1d-baca-dcbb153cec10,
  abstract     = {{<p>A hydraulic force aids diastolic filling of the left ventricle (LV) and is proportional to the difference in short-axis area between the left ventricle and atrium; the atrioventricular area difference (AVAD). Patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) have reduced LV filling which could lead to a negative AVAD and a hydraulic force impeding diastolic filling. The aim was to assess AVAD and to determine whether the hydraulic force aids or impedes diastolic filling in patients with rToF and PR, compared to controls. Twelve children with rToF (11.5 [9–13] years), 12 pediatric controls (10.5 [9–13] years), 12 adults with rToF (21.5 [19–27] years) and 12 adult controls (24 [21–29] years) were retrospectively included. Cine short-axis images were acquired using cardiac magnetic resonance imaging. Atrioventricular area difference was calculated as the largest left ventricular short-axis area minus the largest left atrial short-axis area at beginning of diastole and end diastole and indexed to height (AVADi). Children and adults with rToF and PR had higher AVADi (0.3 cm<sup>2</sup>/m [− 1.3 to 0.8] and − 0.6 [− 1.5 to − 0.2]) at beginning of diastole compared to controls (− 2.7 cm<sup>2</sup>/m [− 4.9 to − 1.7], p = 0.015) and − 3.3 cm<sup>2</sup>/m [− 3.8 to − 2.8], p = 0.017). At end diastole AVADi did not differ between patients and controls. Children and adults with rToF and pulmonary regurgitation have an atrioventricular area difference that do not differ from controls and thus a net hydraulic force that contributes to left ventricular diastolic filling, despite a small underfilled left ventricle due to pulmonary regurgitation.</p>}},
  author       = {{Johansson, Martin and Hedström, Erik and Steding-Ehrenborg, Katarina and Bhat, Misha and Liuba, Petru and Arheden, Håkan and Sjöberg, Pia}},
  issn         = {{0172-0643}},
  keywords     = {{Cardiac magnetic resonance (CMR); Congenital heart defect (CHD); Diastolic function; Hydraulic force; Physiology; Tetralogy of Fallot}},
  language     = {{eng}},
  publisher    = {{Springer}},
  series       = {{Pediatric Cardiology}},
  title        = {{Atrioventricular Area Difference Aids Diastolic Filling in Patients with Repaired Tetralogy of Fallot}},
  url          = {{http://dx.doi.org/10.1007/s00246-024-03508-7}},
  doi          = {{10.1007/s00246-024-03508-7}},
  year         = {{2024}},
}