Systolic Septal Curvature Ratio as a Cardiac MRI Marker of Right Ventricular Loading in Pediatric Congenital Heart Disease.

Authors

Ilker Kemal Yucel, Kevser Banu Kose, Isa Ozyılmaz, Muhammed Faruk Kazanbas, Tuba Banaz, Berk Tutuncuoglu, Yigit Can Kartal, Halise Zeynep Genc, Erkut Ozturk, Kerem Pekkan, Sercin Ozkok

Published in

Pediatric cardiology. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

Right ventricular loading in pediatric congenital heart disease may alter interventricular septal geometry through ventricular interdependence, whereas standard cardiac magnetic resonance imaging (MRI) parameters reflect global ventricular remodeling. This study evaluated the MRI-derived systolic septal-to-free wall curvature ratio across congenital heart disease subgroups with differing loading conditions and examined its relationships with volumetric, functional, and hemodynamic parameters. In this retrospective study, 149 participants examined between 2020 and 2025 were classified as controls (n = 21), repaired tetralogy of Fallot without residual right ventricular outflow tract stenosis (n = 55), repaired tetralogy of Fallot with residual stenosis (n = 52), and left-to-right shunt-associated pulmonary hypertension (n = 21). The end-systolic curvature ratio was calculated from mid-ventricular short-axis cine MRI using MATLAB-based contour analysis. Correlations with MRI-derived and hemodynamic parameters, and diagnostic performance were assessed. The ratio differed among groups (P = 0.0003) and was lowest in the shunt-associated pulmonary hypertension group, followed by tetralogy of Fallot with residual stenosis. In tetralogy of Fallot with residual stenosis, lower ratios were associated with higher peak right ventricular outflow tract gradients (r = - 0.559, P < 0.0001) and higher tricuspid regurgitation-derived right ventricular systolic pressure (r = - 0.447, P = 0.004). In tetralogy of Fallot without residual stenosis, lower ratios were associated with higher right ventricular end-systolic volume index and lower right ventricular ejection fraction. Receiver operating characteristic analysis showed acceptable discrimination, with AUC values of 0.760-0.790 between controls and patient groups and 0.720-0.780 among patient subgroups. The ratio may provide a quantitative noninvasive marker of right ventricular loading and systolic septal deformation, complementing volumetric assessment in pressure-related and mixed loading conditions.

PMID:
42565992
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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