Ventricular Size and Function Assessed by Cardiac MRI Predict Major Adverse Clinical Outcomes Late After Tetralogy of Fallot Repair

Alison L Knauth ¹, Kimberlee Gauvreau ¹, Andrew J Powell ¹, Michael J Landzberg ¹, Edward P Walsh ¹, James E Lock ¹, Pedro J DelNido ¹ and Tal Geva ^1*

¹ Children's Hospital Boston, United States

^* To whom correspondence should be addressed. E-mail: tal.geva{at}cardio.chboston.org.

Accepted 24 October 2006

Abstract

Objectives The goal of this study was to determine independent predictors of major adverse clinical outcomes late after tetralogy of Fallot (TOF) repair in patients evaluated by cardiac magnetic resonance (CMR).

Background We previously reported factors associated with impaired clinical status in a cross-sectional study of patients with repaired TOF. The present study sought to determine outcome predictors in this cohort during follow-up.

Methods Clinical status at latest follow-up was ascertained in 88 patients (median time from TOF repair to baseline evaluation 20.7 years; median follow-up from baseline evaluation to most recent follow-up 4.2 years). Major adverse outcomes included: 1) death; 2) sustained ventricular tachycardia; and 3) increase in NYHA class to grade III or IV.

Results There were 22 major adverse outcomes in 18 patients (20.5%): death in 4, sustained ventricular tachycardia in 8, and increase in NYHA in 10. Multivariate analysis identified right ventricular (RV) end-diastolic volume Z 7 (odd ratio (OR) 4.55, 95% confidence interval (CI) 1.10 to 18.8, p=0.037) and left ventricular (LV) ejection fraction <55% (OR 8.05, 95% CI 2.14 to 30.2, p=0.002) as independent predictors of outcome with an area under ROC curve 0.850. LV ejection fraction could be replaced by RV ejection fraction <45% in the multivariate model. QRS duration 180 ms also predicted major adverse events but correlated with RV size.

Conclusions In this cohort, severe RV dilatation and either LV or RV dysfunction assessed by CMR predicted major adverse clinical events. This information may guide risk stratification and therapeutic interventions.

Keywords: Magnetic Resonance Imaging, complications, outcomes, risk factors, tetralogy of Fallot

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Grotenhuis, H B, Ottenkamp, J, de Bruijn, L, Westenberg, J J M, Vliegen, H W, Kroft, L J M, de Roos, A (2009). Aortic elasticity and size are associated with aortic regurgitation and left ventricular dysfunction in tetralogy of Fallot after pulmonary valve replacement. Heart 95: 1931-1936 [Abstract] [Full Text]  
• Harrild, D. M., Berul, C. I., Cecchin, F., Geva, T., Gauvreau, K., Walsh, E. P., Pigula, F. (2009). Response to Letter Regarding Article, "Pulmonary Valve Replacement in Tetralogy of Fallot: Impact on Survival and Ventricular Tachycardia". Circulation 120: e80-e80 [Full Text]  
• Dos, L., Dadashev, A., Tanous, D., Ferreira-Gonzalez, I. J., Haberer, K., Siu, S. C., Van Arsdell, G. S., Oechslin, E. N., Williams, W. G., Silversides, C. K. (2009). Pulmonary valve replacement in repaired tetralogy of Fallot: Determinants of early postoperative adverse outcomes. J. Thorac. Cardiovasc. Surg. 138: 553-559 [Abstract] [Full Text]  
• Nordmeyer, J., Tsang, V., Gaudin, R., Lurz, P., Frigiola, A., Jones, A., Schievano, S., van Doorn, C., Bonhoeffer, P., Taylor, A. M. (2009). Quantitative assessment of homograft function 1 year after insertion into the pulmonary position: impact of in situ homograft geometry on valve competence. Eur Heart J 30: 2147-2154 [Abstract] [Full Text]  
• Zervan, K., Male, C., Benesch, T., Salzer-Muhar, U. (2009). Ventricular interaction in children after repair of tetralogy of Fallot: a longitudinal echocardiographic study. Eur J Echocardiogr 10: 641-646 [Abstract] [Full Text]  
• Flett, A. S., Westwood, M. A., Davies, L. C., Mathur, A., Moon, J. C. (2009). The Prognostic Implications of Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2: 243-250 [Full Text]  
• Wald, R. M., Haber, I., Wald, R., Valente, A. M., Powell, A. J., Geva, T. (2009). Effects of Regional Dysfunction and Late Gadolinium Enhancement on Global Right Ventricular Function and Exercise Capacity in Patients With Repaired Tetralogy of Fallot. Circulation 119: 1370-1377 [Abstract] [Full Text]  
• Wald, R. M., Redington, A. N., Pereira, A., Provost, Y. L., Paul, N. S., Oechslin, E. N., Silversides, C. K. (2009). Refining the assessment of pulmonary regurgitation in adults after tetralogy of Fallot repair: should we be measuring regurgitant fraction or regurgitant volume?. Eur Heart J 30: 356-361 [Abstract] [Full Text]  
• Harrild, D. M., Berul, C. I., Cecchin, F., Geva, T., Gauvreau, K., Pigula, F., Walsh, E. P. (2009). Pulmonary Valve Replacement in Tetralogy of Fallot: Impact on Survival and Ventricular Tachycardia. Circulation 119: 445-451 [Abstract] [Full Text]  
• Silka, M. J., Bar-Cohen, Y. (2008). Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?: Patients With Congenital Heart Disease and a Systemic Ventricular Ejection Fraction Less Than 30% Should Undergo Prophylactic Implantation of an Implantable Cardioverter Defibrillator. Circ Arrhythm Electrophysiol 1: 298-306 [Full Text]  
• Triedman, J. K. (2008). Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?: Implantable Cardioverter Defibrillator Implantation Guidelines Based Solely on Left Ventricular Ejection Fraction Do Not Apply to Adults With Congenital Heart Disease. Circ Arrhythm Electrophysiol 1: 307-316 [Full Text]