Department of Pediatrics, Division of Cardiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Int J Cardiol. 2013 Aug 10;167(3):833-9. doi: 10.1016/j.ijcard.2012.02.011. Epub 2012 Mar 3.
Atrial enlargement may reflect ventricular diastolic dysfunction. Although patients with tetralogy of Fallot (TOF) have been studied extensively, little is known about atrial size and function. We assessed bi-atrial size and function in patients after TOF repair, and related them to biventricular systolic and diastolic function, and clinical parameters.
51 Patients (21 ± 8 years) and 30 healthy controls (31 ± 7 years) were included and underwent magnetic resonance imaging to assess bi-atrial and biventricular size, systolic and diastolic function. Patients also underwent exercise testing, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) assessment.
In patients, right atrial (RA) minimal volume (34 ± 8 ml/m(2) vs. 28 ± 8 ml/m(2), p=0.001) and late emptying fraction were increased; RA early emptying fraction was decreased. Patients had longer right ventricular (RV) deceleration time (0.24 ± 0.10 vs. 0.13 ± 0.04, p<0.001), reflecting impaired RV relaxation, and larger RV volumes. Patients with end-diastolic forward flow (EDFF) had larger RA and RV size, abnormal RA emptying, higher NT-proBNP levels, higher VE/VCO2 slope (ventilatory response to carbon dioxide production), and the most abnormal LV diastolic function (impaired compliance). Patients with abnormal RA emptying (reservoir function <30% and pump function >24%) had higher NT-proBNP levels and worse exercise capacity. RA minimal volume was associated with RV end-diastolic volume (r=0.35, p=0.013).
In TOF patients with moderate RV dilatation, abnormal bi-atrial function and biventricular diastolic dysfunction are common. Abnormal RA emptying was associated with signs of impaired clinical condition, as was the presence of EDFF. These parameters, together with RA enlargement, could serve as useful markers for clinically relevant RV diastolic dysfunction.
心房扩大可能反映心室舒张功能障碍。尽管已广泛研究法洛四联症（TOF）患者，但对于心房大小和功能知之甚少。我们评估了 TOF 修复后的患者的双心房大小和功能，并将其与双心室收缩和舒张功能以及临床参数相关联。
纳入 51 例患者（21 ± 8 岁）和 30 例健康对照者（31 ± 7 岁），并进行磁共振成像评估双心房和双心室的大小、收缩和舒张功能。患者还进行了运动测试和 N 末端脑利钠肽前体（NT-proBNP）评估。
患者的右心房（RA）最小容积（34 ± 8 ml/m2 比 28 ± 8 ml/m2，p=0.001）和晚期排空分数增加；RA 早期排空分数降低。患者的右心室（RV）减速时间更长（0.24 ± 0.10 比 0.13 ± 0.04，p<0.001），反映 RV 舒张功能受损，RV 容积增大。存在舒张末期前向血流（EDFF）的患者 RA 和 RV 大小较大，RA 排空异常，NT-proBNP 水平较高，VE/VCO2 斜率（二氧化碳产生的通气反应）较高，LV 舒张功能最异常（顺应性降低）。RA 排空异常（储备功能<30%和泵功能>24%）的患者 NT-proBNP 水平较高，运动能力较差。RA 最小容积与 RV 舒张末期容积相关（r=0.35，p=0.013）。
在伴有中度 RV 扩张的 TOF 患者中，异常的双心房功能和双心室舒张功能很常见。RA 排空异常与临床状况受损的迹象相关，EDFF 的存在也是如此。这些参数与 RA 扩大一起，可作为有临床意义的 RV 舒张功能障碍的有用标志物。
