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Background: Pulmonary insufficiency (PI) with right ventricular (RV) dilatation is common after tetralogy of Fallot (ToF) repair. RV myocardial deformation is reduced in ToF patients but the PI-related RV dilatation and strain (S) and strain rate (SR) is not well studied.Aim: To evaluate the relationship between RV S and SR and PI-related RV dilatation.Methods and results: Sixty pts were studied: 40 pts after ToF repair and 20 age matched controls. All pts underwent an echocardiography at the time of a clinically indicated MRI. Ultrasound images were acquired using a GE Vivid 7 (GE Ultrasound, USA). For RV longitudinal deformation the RV lateral S and SR were obtained from an apical four chamber view using speckle tracking technique. Cardiac MRI was used to quantify RV volumes and pulmonary regurgitant volume (PRV). RV deformation parameters were significantly decreased in the ToF group compared to controls: S -22.8±4.7% vs−34±5.2%, p<0.001; SR -1.41±0.3s-1 vs −2.59±0.6s-1, p<0.001. RV EDV correlated negatively with S (R= 0.74) and SR (R=0.68). Correlations were also significant for the end systolic volume (R= 0.7 and 0.63 resp), but not for RV ejection fraction. A significant inverse relationship could be observed between PRV and EDV corrected S and SR(figure). Interestingly, some patients with only mild/moderate PI had very low corrected deformation values which might indicate RV dysfunction in the absence of PI.Conclusion: In ToF patients, RV dilatation is associated with reduced strain. Correcting RV deformation for RV dilatation theoretically could better represent RV function and the negative relationships between S/EDV and PRV suggest that progressive PI negatively affects RV function, irrespective of the effect of RV volume.