Kutty S, et al. - The associations of pulmonary arterial end-diastolic forward flow (EDFF) in patients with repaired tetralogy of Fallot (rTOF), with pulmonary regurgitation (PR), right ventricular (RV) size and function, and so-called ‘restrictive’ RV physiology were determined via retrospective analysis of large cohort of patients with rTOF who had contemporaneous echocardiography (Echo) and cardiovascular magnetic resonance (CMR) studies. A common occurrence of EDFF in rTOF patients was reported, its presence and extent varied between Echo and CMR. The association of EDFF with greater PR and larger RV size but not with markers of poor RV compliance such as right atrial enlargement was shown. It was also noted that mechanisms beyond RV noncompliance may contribute to the presence of EDFF.

• Researchers performed a retrospective analysis of 399 patients with rTOF who had contemporaneous echocardiography (Echo) and cardiovascular magnetic resonance (CMR) studies.

• Data showed that the median age at TOF repair was 0.7 years [0.21, 2.66], age at CMR was 19.8 years [13.0, 29.4], and interval between Echo and CMR was 48 days [0, 182].
• EDFF was detected in 122 (31%) patients by Doppler and in 113 patients (28%) via CMR.
• Researchers noted that patients with EDFF vs those without EDFF were younger, had greater PR, and higher RV end-diastolic volume (EDV), stroke volume, and ejection fraction.
• They noted that there was no difference in the markers of RV restriction such as right atrial size between the groups.
• EDFF was related to higher RV stroke volume and lower LV EDV, as revealed on multivariable regression.
• In addition, modest association between Echo and CMR measurements of EDFF was shown (area under the ROC curve = 0.684, r = 0.374, p <0.001).