ArticlePediatric cardiology2026
Systolic Septal Curvature Ratio as a Cardiac MRI Marker of Right Ventricular Loading in Pediatric Congenital Heart Disease.
Article in Pediatric cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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