Altered aortic upper wall TDI velocity is inversely related with left ventricular diastolic function in operated tetralogy of Fallot

Objective: Postoperative tetralogy of Fallot (TOF) patients often develop progressive aortic root dilatation due to an impairment in aortic elastic properties. Aims: (1) to assess aortic elasticity at the level of the aortic upper wall by tissue Doppler imaging (TDI); (2) to evaluate the influence of aortic elasticity on left ventricular (LV) diastolic function in TOF patients. Design: Twenty-eight postoperative TOF patients (14 males, 14 females. Mean age: 25.7±1.6 years) and 28 age- and sex-matched normal subjects were examined. Aortic distensibility and stiffness index were calculated. Aortic wall systolic and diastolic velocities, LV systolic and diastolic parameters were assessed by TDI. Results: Aortic distensibility was significantly lower (P=.024), and aortic stiffness index significantly higher (P=.036) in TOF patients compared to controls. E/E′ was significantly higher in TOF than in control group (P<.001). Aortic upper wall early diastolic velocity (AWEDV) was significantly correlated with aortic stiffness index (r: -0.42; P < .03), aortic distensibility (r=0.54; P<.004), left atrial volume (r=-0.62; P=.0004), and E/E′ ratio (r=-0.87; P<.0001). The latter relationship remained significant even when excluding the influence of age at surgery (r=-0.60; P < .0007) and of previous palliative surgery (r=-0.53; P<.02). Conclusions: Aortic elastic properties can be directly assessed using TDI to measure AWEDV. Aortic elasticity is significantly lower in postoperative TOF patients, exerting a negative effect also on LV diastolic function, with a potential long-term influence on clinical status.