Virginia Via Research Day Book 2026

Medical Student Research Clinical

E.Thompson, MS-IV; N. Dong; J. Kim; A. Bhattaru; P. Vu; F. Hu; R. Shinohara; S. Swago; E. Donnelly; X. Zhang; A. Loth; L. Vuthuri, OMS-II; K. Lanzilotta; K. Whitehead; J. Duda; J. Gee; L. Almasy; E. Goldmuntz; M. Fogel, MD; W. Whitschey, PhD Corresponding author: lvuthuri@vcom.edu CARDIOVASCULAR MAGNETIC RESONANCE IMAGING TRAITS ASSOCIATED WITH ADVERSE RIGHT VENTRICULAR REMODELING IN REPAIRED TETRALOGY OF FALLOT: A SINGLE CENTER OUTCOMES USING CARDIOVASCULAR MAGNETIC RESONANCE IN TETRALOGY OF FALLOT STUDY 38

University of Pennsylvania, Philadelphia, Pennsylvania Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Conventional volumetric indices (EDVi, ESVi, SVi, EF) and a novel temporal contractility-related metric (peak systolic dV/dt) were computed. Remodeling rates were calculated as (scan 2-−scan 1) divided by years between scans. Remodeling rates were compared between patients with PVR between scans and those with no intervention. In patients without PVR between scans, multivariable linear regression was used to evaluate baseline imaging predictors of RV remodeling, adjusting for sex, age at both scans, and pulmonary regurgitation, with multiple-comparison correction. Results: Among 758 rToF patients, 152 had two analyzable CMR studies; 36 underwent PVR between scans, and 116 had no PVR between scans. Compared to the no-intervention group, patients who underwent PVR had significantly lower RV remodeling rates, including RVEDVi (median ΔRVEDVi/year 1.37 vs −7.53 mL/m²/year, p < 0.001) and absolute peak systolic RV dV/dt (median Δ|RV dV/dt|/year 0.0178 vs −0.0215 mL/ms/year, p < 0.001), reflecting opposite-direction remodeling trajectories. Remodeling rates for RVEF and LV metrics did not significantly differ between groups (e.g., ΔRVEF/year p = 0.416). In the natural-history group (no PVR between scans), RV remodeling rates

were negatively associated with baseline LV mass index, LVEDVi, LVSVi, and absolute peak systolic LV dV/dt, suggesting that baseline LV structure and function are linked to future RV remodeling risk. Conclusions: ML-based automated CMR analysis can quantify longitudinal remodeling in rToF and reveals significantly different and opposite-direction RV remodeling patterns following PVR compared with no intervention. Baseline LV structural and functional measures are associated with adverse RV remodeling in the natural history of rToF, supporting the importance of LV assessment when characterizing future RV remodeling risk. IRB Statement: This study was approved by the Children's Hospital of Philadelphia Institutional Review Board (February 28, 2021; IRB number 17-014719

Context: Repaired tetralogy of Fallot (rToF) patients remain at risk for progressive right ventricular (RV) dilation and dysfunction, which can lead to arrhythmias, re-intervention, and heart failure. Cardiovascular magnetic resonance (CMR) is the clinical gold standard for monitoring RV remodeling, but conventional CMR post-processing is time-consuming and user-dependent, limiting scalable longitudinal evaluation. This study addresses the need for automated and standardized imaging biomarkers to better characterize adverse RV remodeling over time. Objective: To determine whether machine learning (ML)-automated CMR analysis can identify imaging traits associated with adverse RV remodeling in the natural history of rToF and distinguish remodeling patterns in patients with versus without pulmonic valve replacement (PVR). Methods: A longitudinal cohort of rToF patients underwent serial CMR at the Children's Hospital of Philadelphia. An nnU-Net ML segmentation model was trained to automatically segment the left ventricular (LV) blood pool, LV myocardium, and RV blood pool from two-dimensional short-axis cine CMR images.

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208 Edward Via College of Osteopathic Medicine (VCOM)