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Published on: July 19, 2013
Prognostic Value of Cardiac MRI-derived Left Atrial and Biventricular Function in Children with Repaired Tetralogy of
Yanyan Ma1, Rongzhen Ouyang1, Liwei Hu2
1Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Dongfang Road 1678, Shanghai 200127, China.
Insights
Left atrial dysfunction detected by cardiac MRI offers improved prognostication for children with repaired tetralogy of Fallot (rTOF). Incorporating left atrial conduit strain enhances risk prediction beyond standard right ventricular measures.
Area of Science:
- Cardiology
- Pediatric Imaging
- Congenital Heart Disease
Background:
- Repaired tetralogy of Fallot (rTOF) can lead to long-term cardiac complications.
- Assessing prognosis in pediatric rTOF patients is crucial for management.
- Biventricular function is routinely monitored, but left atrial function's role is less understood.
Purpose of the Study:
- To determine if left atrial (LA) function, assessed via cardiac MRI, provides additional prognostic information in pediatric rTOF patients.
- To compare LA function between children with rTOF and healthy controls.
- To evaluate the incremental prognostic value of LA function beyond biventricular parameters.
Main Methods:
- Prospective study involving pediatric participants with rTOF and healthy controls.
- Cardiac MRI was used to measure LA size, ejection fraction (EF), strain, strain rate, and biventricular volumes, mass, and global longitudinal strain (GLS).
- Cox regression analysis was performed to assess the association between cardiac MRI parameters and endpoint events (heart failure hospitalization, reoperation).
Main Results:
- Children with rTOF showed impaired LA function (lower reservoir EF, strain, strain rate; lower conduit EF, strain) compared to controls, despite normal biventricular GLS.
- Impaired LA conduit strain, impaired right ventricular (RV) GLS, and higher end-systolic volume index were independently associated with adverse outcomes.
- Adding LA conduit strain to RV GLS models significantly improved prognostic prediction (increased concordance index, integrated discrimination improvement, and net reclassification improvement).
Conclusions:
- Left atrial dysfunction is present in pediatric rTOF patients even with preserved ventricular function.
- Cardiac MRI assessment of LA conduit strain offers incremental prognostic value in pediatric rTOF.
- Integrating LA conduit strain into risk stratification models can improve the prediction of adverse events in this population.
Abstract:
Purpose To evaluate whether left atrial (LA) function assessed with cardiac MRI provides incremental prognostic value beyond biventricular function in children with repaired tetralogy of Fallot (rTOF). Materials and Methods In this prospective study, pediatric participants with rTOF were consecutively recruited between August 2019 and December 2021 and healthy controls from July 2017 to August 2018. All participants underwent cardiac MRI. Measurements included LA size, ejection fraction (EF), strain, and strain rate across reservoir, conduit, and pump phases, and biventricular volumes, mass, and global longitudinal strain (GLS). Late gadolinium enhancement was assessed in rTOF. End point events were heart failure hospitalization and reoperation. Cox regression analysis was performed. Model performance was assessed using Harrell concordance index, integrated discrimination improvement, and net reclassification improvement. Results Seventy-eight participants with rTOF (mean age, 10.73 years ± 3.66 [SD]; 47 male) and 30 controls (mean age, 11.06 years ± 2.97; 21 male) were included. Compared with controls, participants with rTOF demonstrated LA dysfunction, with lower reservoir EF, strain, and strain rate, lower conduit EF and strain, and higher pump EF, while biventricular GLS remained normal. Over a median follow-up of 2 years, impaired LA conduit strain (<15.83%), impaired right ventricular (RV) GLS (<22.66%), and higher end-systolic volume index were independently associated with end point events (hazard ratio = 4.72, 2.75, and 1.02, respectively). Adding impaired LA conduit strain into the RV GLS model increased the concordance index from 0.74 to 0.82 (P < .001) with an integrated discrimination improvement of 0.13 (P = .006) and net reclassification improvement of 0.89 (P < .001). Conclusion In pediatric rTOF with preserved ventricular EF and GLS, LA dysfunction at cardiac MRI was evident. Incorporating LA conduit strain alongside established RV functional parameters improved prognostic assessment during follow-up. Keywords: Pediatrics, MR Imaging, Cardiac, Left Atrium, Right Ventricle, Congenital, Outcomes Analysis, Cardiac MRI, Congenital Heart Disease, Tetralogy of Fallot, Left Atrial Function Supplemental material is available for this article. © RSNA, 2026.
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