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Right Ventricular Restrictive Physiology Is Associated With Right Ventricular Direct Flow From 4D Flow CMR
Xiaodan Zhao1, Phong Teck Lee1, Liwei Hu2
1National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.
Right ventricular restrictive physiology (RVRP) in repaired tetralogy of Fallot (rTOF) is linked to altered biventricular blood flow and kinetic energy. Increased direct flow is a key predictor of RVRP in these patients.
Area of Science:
- Cardiovascular Imaging
- Congenital Heart Disease
- Hemodynamics
Background:
- Right ventricular restrictive physiology (RVRP) is common in repaired tetralogy of Fallot (rTOF).
- The relationship between RVRP and biventricular blood flow dynamics, including kinetic energy (KE), using 4-dimensional (4D) flow cardiovascular magnetic resonance (CMR) is not well understood.
Purpose of the Study:
- To investigate the association between 4D flow CMR-derived parameters and RVRP in patients with rTOF.
Main Methods:
- 103 rTOF patients and 62 controls underwent CMR (cine, 2D PC, 4D flow) and exercise testing.
- RVRP was identified using pulmonary artery flow curves.
- Biventricular flow components and KE (normalized to end-diastolic volume, KEiEDV) were analyzed.
Main Results:
- rTOF patients exhibited lower RV direct flow and higher RV residual volume compared to controls.
- RVRP was present in 68% of rTOF patients, associated with increased RV direct flow and peak E-wave KEiEDV, and decreased RV residual volume.
- RV direct flow emerged as an independent predictor of RVRP (OR: 1.158, P < 0.001).
Conclusions:
- RVRP in rTOF is associated with dilated RV, increased pulmonary regurgitation, and elevated RV direct flow.
- 4D flow CMR parameters, particularly RV direct flow, can help identify RVRP in rTOF patients.
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