Morphological Markers and Determinants of Left Ventricular Systolic Dysfunction in Repaired Tetralogy of Fallot

Patients with repaired tetralogy of Fallot (rTOF) are at risk of long-term left ventricular (LV) dysfunction associated with poor outcomes. In this study, we examined the association of LV end-diastolic (ED) shape with components of systolic wall motion (SWM) that contribute to global systolic dysfunction in an rTOF patient cohort. Features of LV shape associated with conicity and septal wall curvature correlated with components of SWM. The effect of ED shape perturbations on SWM were examined in a finite element analysis of systolic ventricular mechanics. Variations in the combination of ED shape and myocardial contractility were able to match predicted measures of SWM. From these results, we hypothesize that greater LV conicity and a flatter septal wall are markers of reduced global myocardial contractility and should be examined further for clinical prognostic utility to improve patient outcomes.