Adverse remodelling in tetralogy of Fallot: From risk factors to imaging analysis and future perspectives

Trends in Tetralogy of Fallot-Related Mortality in the United States Between 1999 and 2020

We sought to identify mortality trends related to Tetralogy of Fallot (ToF) in the U.S. population, with specific emphasis on age-related, racial, and geographic differences. Death certificate data was retrieved from the CDC WONDER database, where crude mortality rate (CMR) and age-adjusted mortality rates (AAMR) with 95% CIs per 1,000,000 population were identified, along with annual percentage changes (APCs) and average annual percentage change (AAPC) determined by Joinpoint regression. From 1999 to 2020, a total of 5523 deaths were reported in association with ToF, with nearly half of all deaths occurring during the first year of life. The AAMR steadily decreased from 1999 to 2020 (AAPC: - 1.26, 95% CI - 2.29 to -0.38, p-value = 0.012). Males had a slightly higher AAMR (0.91) than females (0.77). Non-Hispanic (NH) Blacks/African Americans had a higher AAMR (1.00) compared with NH Whites (0.83). Infants less than a year old exhibited the highest CMRs among all age groups. Although lower rates were seen among all age strata < 45 years of age, deaths in patients > 45 years significantly increased from 2013 to 2020 (APC 6.17, 95% CI 0.79 to 20.35, p-value = 0.047). Rural areas consistently exhibited greater AAMRs and lesser declines over time compared to urban areas, with most deaths occurring in medical facilities. Over the last 2 decades in the US, the mortality rates associated with ToF have steadily decreased. Focusing resources on these higher risk populations may prove beneficial.

The mechanics of congenital heart disease: from a morphological trait to the functional echocardiographic evaluation

Advances in pediatric cardiac surgery have resulted in a recent growing epidemic of children and young adults with congenital heart diseases (CHDs). In these patients, congenital defects themselves, surgical operations and remaining lesions may alter cardiac anatomy and impact the mechanical performance of both ventricles. Cardiac function significantly influences outcomes in CHDs, necessitating regular patient follow-up to detect clinical changes and relevant risk factors. Echocardiography remains the primary imaging method for CHDs, but clinicians must understand patients' unique anatomies as different CHDs exhibit distinct anatomical characteristics affecting cardiac mechanics. Additionally, the use of myocardial deformation imaging and 3D echocardiography has gained popularity for enhanced assessment of cardiac function and anatomy. This paper discusses the role of echocardiography in evaluating cardiac mechanics in most significant CHDs, particularly its ability to accommodate and interpret the inherent anatomical substrate in these conditions.