Ventriculo-Arterial Coupling estimation by Cardiac MRI as a potential biomarker in patients with repaired Tetralogy of Fallot

Motivation: Ventriculo-arterial coupling ratio (VAC) is useful to assess the relationship between ventricle performance and the arterial system and may be estimated non-invasively using CMR. Goal(s): Our goal was to determine if the non-invasive VAC (nVAC) was accurate in patients with repaired Tetralogy of Fallot and if it predicts outcomes. Approach: We compared the CMR-derived right and left ventricular (RV and LV) nVAC with invasive VAC, and separately compared nVAC with outcomes in large clinical registries. Results: CMR provides an accurate estimate of nVAC. Patients with events had a significantly higher RV and LV nVAC than those without events. Impact: CMR-derived Ventriculo-Arterial Coupling (VAC) ratio accurately reflects the invasively derived VAC and may be used as an indicator for possible future cardiac events and therefore improve risk stratification in patients with repaired Tetralogy of Fallot.