Assessment of inter-atrial, inter-ventricular, and atrio-ventricular interactions in tetralogy of Fallot patients after surgical correction. Insights from two-dimensional speckle tracking and three-dimensional echocardiography.

Background: We aimed to assess biatrial size and function, interactions on atrial and ventricular levels, and atrio-ventricular coupling in patients after tetralogy of Fallot repair. Methods: A total of 34 patients with a mean age of 20.9 +/- 9 years, and 35 healthy controls, underwent two-dimensional speckle tracking echocardiography for ventricular and atrial strain measurements and real-time three-dimensional echocardiography to assess ventricular and atrial volumes. Results: When compared with controls, tetralogy of Fallot patients had significantly reduced right atrial peak atrial longitudinal strain (p < 0.01), right atrial peak atrial contraction strain (p < 0.01), right atrial ejection fraction (p < 0.01), left atrial peak atrial longitudinal strain (p < 0.01), left atrial peak atrial contraction strain (p < 0.05), and left atrial ejection fraction (p < 0.01). In the tetralogy of Fallot group, left ventricular ejection fraction was negatively related to the right ventricular end-systolic volume normalised to body surface area (r = -0.62, p < 0.01). An association was found in patients between the right atrial peak longitudinal strain and mean right ventricular strain (r = 0.64, p < 0.01). In patients, the left atrial peak longitudinal strain correlated negatively with right atrial end-diastolic volume normalised to body surface area (r = -0.67, p < 0.01), whereas the left atrial ejection fraction correlated weakly with left ventricular ejection fraction (r = 0.41, p < 0.05). Conclusions: In asymptomatic tetralogy of Fallot patients, biatrial dysfunction exists and can be quantified via two-dimensional speckle tracking echocardiography as well as real-time three-dimensional echocardiography. Different forms of interactions on atrial and ventricular levels are evident among such cohorts.