Evaluation of left atrial dysfunction in pediatric and adult patients with repaired tetralogy of Fallot using two- dimensional speckle-tracking echocardiography

Abstract

Abstract Purpose: Although the left atrium (LA) plays a key role in diastolic function, LA dysfunction in patients with repaired tetralogy of Fallot (rTOF) remains unclear. Therefore, we aimed to evaluate left atrial function and investigate changes with age in patients with rTOF using speckle-tracking echocardiography. Methods: We compared 62 patients with rTOF with 62 healthy similar age- and sex-matched controls divided into three age groups (T1, C1: 3–9 years [children], T2, C2: 10–19 years [adolescents and young adults], and T3, C3: 20–44 years [adults]). LA strain was assessed by two-dimensional speckle-tracking echocardiography and defined according to its three distinct phases, with the LA serving as a reservoir during systole, conduit during early diastole, and booster pump at the end of diastole. Furthermore, we examined the correlations between LA strains and left ventricular longitudinal strain (LVLS) and conventional echocardiographic parameters. Results:The LA reservoir and pump strains were lower in the T3 group than in the C3 group. In T1 and T2 groups, no significant differences in any LA strains were reported. LA functions based on LA volume did not show any difference between TOF and controls among all age groups. All LA strains only moderately or weakly correlated with LVLS and mitral E/A, but not with LV lateral e’ nor E/e’. Conclusions: LA phasic function decreases in adult patients with rTOF. These parameters can potentially be used as sensitive indicators of diastolic dysfunction in patients with rTOF.