Abstract
Background: Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics.
Methods: Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV).
Results: Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (−15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = −0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37).
Conclusions: We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF.
Document Type
Article
Publication Date
12-11-2017
Digital Object Identifier (DOI)
https://doi.org/10.1186/s12968-017-0410-2
Funding Information
This work was supported by a National Institutes of Health (NIH) Director’s Early Independence Award (DP5 OD-012132).
Related Content
The datasets generated and/or analyzed during the current study are available on reasonable request with approval of the corresponding author.
Repository Citation
Haggerty, Christopher M.; Suever, Jonathan D.; Pulenthiran, Arichanah; Mejia-Spiegeler, Abba; Wehner, Gregory J.; Jing, Linyuan; Charnigo, Richard J.; Fornwalt, Brandon K.; and Fogel, Mark A., "Association Between Left Ventricular Mechanics and Diffuse Myocardial Fibrosis in Patients with Repaired Tetralogy of Fallot: A Cross-Sectional Study" (2017). Biomedical Engineering Faculty Publications. 19.
https://uknowledge.uky.edu/cbme_facpub/19
Notes/Citation Information
Published in Journal of Cardiovascular Magnetic Resonance, v. 19, 100, p. 1-10.
© The Author(s). 2017
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.