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Original article
Relationship between temporal sequence of right ventricular deformation and right ventricular performance in patients with corrected tetralogy of Fallot
  1. Annelies E van der Hulst1,
  2. Arno A W Roest1,
  3. Victoria Delgado2,
  4. Eduard R Holman2,
  5. Albert de Roos3,
  6. Nico A Blom1,
  7. Jeroen J Bax2
  1. 1Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Arno AW Roest, Division of Pediatric Cardiology, Department of pediatrics J6-S Albinusdreef 2, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands; a.roest{at}


Objective Right ventricular (RV) dysfunction is common in patients with corrected tetralogy of Fallot (cToF). Abnormalities in the temporal pattern of RV mechanical activation have been observed in patients with cToF, but the relationship with RV performance remains unclear. This study characterises RV performance and the temporal sequence of RV deformation in patients with cToF and healthy controls.

Study design 37 patients with cToF were compared with 18 controls. Using two-dimensional speckle tracking analysis, global RV strain was assessed. In addition, time to peak strain and the time difference between RV inlet and RV outlet (RV time delay) was assessed.

Main outcome measure The relation between RV performance and RV time delay was assessed with linear regression analysis.

Results RV strain was reduced in patients compared with controls (−20.9±4.3% vs −30.7±3.4%, p<0.001). Time to peak strain at the RV inlet showed no differences between patients with cToF and controls (406±55 ms vs 405±67 ms, p=0.429), whereas time to peak strain at the RV outlet was significantly delayed in patients with cToF (339±75 ms vs 262±85 ms, p=0.003). Consequently, RV time delay was significantly shorter in patients with cToF than in controls (66±48 ms vs 143±53 ms, p<0.001). A close relation between RV time delay and RV strain was observed (r=−0.70, p<0.001).

Conclusion In patients with cToF, RV outlet deformation is delayed, causing a reduction in RV time delay which is significantly related to impairment in RV performance.

  • Tetralogy of Fallot
  • echocardiography
  • mechanics
  • fallots tetralogy
  • echocardiography-paediatrics

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  • Funding AEvdH is financially supported by a grant from the Willem-Alexander KinderFonds, Leiden The Netherlands. AAWR is supported by a grant of the Netherlands Heart Foundation (2008T81).

  • Competing interests JJB has received research grants from Biotronik (Berlin, Germany), Medtronic (Minneapolis, MN), Boston Scientific Corporation (Natick, MA), Bristol-Myers Squibb Medical Imaging (New York, NY), St Jude Medical (St Paul, MN), GE Healthcare (Milwaukee, WI), and Edwards Lifesciences (Irvine, CA).

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Leiden University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.