Egbe AC, et al. - Given that mortality in patients with heart failure attributed to acquired heart disease is predicted by right atrial pressure (RAP), a composite metric of right ventricular diastolic function, volume status, and right heart compliance, researchers determined if RAP would be related to disease severity and cardiovascular adverse events in patients with tetralogy of Fallot (TOF) as these patients might have abnormal right atrial and ventricular mechanics induced by myocardial injury and remodeling. In this cohort study, they examined adults with TOF who had right heart catheterization at the Mayo Clinic Rochester between 1990 and 2017. Overall 225 patients (including 113 male; mean age: 39 ± 14 years) were investigated. Mean and median RAP was 10.7 ± 5.2 mm Hg and 10 mm Hg, respectively. They reported atrial or ventricular arrhythmias, heart failure hospitalization per 5 mm Hg, and worsening exercise capacity in relation to increasing RAP. Among symptomatic patients with TOF, findings revealed a correlation of increasing RAP with multiple domains of disease severity (risk stratification). In these patients, future cardiovascular events (prognostication) were also predicted by increasing RAP.