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Left Ventricular Torsion Obtained Using Equilibrated Warping in Patients with Repaired Tetralogy of Fallot

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Daniel Alexander Castellanos, Kateřina Škardová, Abhijit Bhattaru, Ezgi Berberoglu, Gerald Greil, Animesh Tandon, Jeanne Dillenbeck, Barbara Burkhardt, Tarique Hussain, Martin Genet, Radomir Chabiniok

Original languageEnglish
Pages (from-to)1275-1283
Number of pages9
JournalPediatric Cardiology
Issue number6
Accepted/In press2021
PublishedAug 2021

Bibliographical note

Funding Information: This study was funded in part from by the W. B. & Ellen Gordon Stuart Trust, The Communities Foundation of Texas, and by the Pogue Family Distinguished Chair (award to Dr F. Gerald Greil in February, 2015). Research reported in this publication was supported by Children’s Health but the content is solely the responsibility of the authors and does not necessarily represent the official views of Children’s Health. The study was also partially supported by the Inria-UTSW Associated Team TOFMOD. K. Škardová and R. Chabiniok were partially supported by project No. NV19-08-00071 of the Ministry of Health of the Czech Republic. SM SM Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Patients after surgical repair of Tetralogy of Fallot (rTOF) may suffer a decrease in left ventricular (LV) function. The aim of our study is to evaluate a novel method of assessing LV torsion in patients with rTOF, as an early indicator of systolic LV dysfunction. Motion tracking based on image registration regularized by the equilibrium gap principle, known as equilibrated warping, was employed to assess LV torsion. Seventy-six cases of rTOF and ten normal controls were included. The group of controls was assessed for reproducibility using both equilibrated warping and standard clinical tissue tracking software (CVI42, version 5.10.1, Calgary, Canada). Patients were dichotomized into two groups: normal vs. loss of torsion. Torsion by equilibrated warping was successfully obtained in 68 of 76 (89%) patients and 9 of 10 (90%) controls. For equilibrated warping, the intra- and interobserver coefficients of variation were 0.095 and 0.117, respectively, compared to 0.260 and 0.831 for tissue tracking by standard clinical software. The intra- and inter-observer intraclass correlation coefficients for equilibrated warping were 0.862 and 0.831, respectively, compared to 0.992 and 0.648 for tissue tracking. Loss of torsion was noted in 32 of the 68 (47%) patients with rTOF. There was no difference in LV or RV volumes or ejection fraction between these groups. The assessment of LV torsion by equilibrated warping is feasible and shows good reliability. Loss of torsion is common in patients with rTOF and its robust assessment might contribute into uncovering heart failure in an earlier stage.

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