In recent years, the prognostic utility and clinical relevance of left atrial function assessed by 2D strain analysis, particularly peak longitudinal left atrial (LA) strain, has emerged as noteworthy in the prediction of outcomes in different forms of acquired heart disease, and there is increasing data egarding its relevance in CHD. Although LA function abnormalities have been previously described in patients with Tetralogy of Fallot, LA function remains poorly explored and incompletely characterized late after c-ToF. In addition, its clinical utility has not yet been clearly investigated in this population of patients at risk of particularly cardiac arrhythmia. In this study, we aimed to characterize LA mechanics and function by 2D strain analysis, in adult patients with c-ToF and to examine the relationships between LA function and patient characteristics, especially history of life-threatening ventricular arrhythmia (h-LTVA).

The objectives of this study were to examine LA function and compliance using two-dimensional (2D) strain analysis in adult patients with corrected c-ToF and to investigate the relationships between LA function and patient characteristics, especially history of life-threatening arrhythmia (h-LTA).

Fifty-one c-ToF patients (34 males; age, 39±15 years; h-LTA, n=13) were included in this retrospective monocenter study. In addition to a 2D standard echocardiography examination, 2D strain analysis was performed to assess left ventricular and LA functions, including peak-positive LA strain (LAS - reservoir function) and LA compliance (defined as the ratio LAS/(E/Ea)).

Patients with h-LTA were older and exhibited a longer QRS duration. LV ejection fraction, LAS and LA compliance were significantly lower in the group of patients with h-LTA. Indexed LA and RA volumes, RV end-diastolic area was significantly higher and RV fractional area change significantly lower in the h-LTA group. LA compliance was the best echocardiographic predictor for h-LTA (AUC: 0.839; p<0.001). Moderate inverted correlations were found between LA compliance and age and QRS duration. Among the echocardiographic parameters, LA compliance was moderately inversely correlated with RV end-diastolic area (r=−0.40, p=0.01).

We documented abnormal LAS and LA compliance values in adult c-ToF patients.