Article Text

PDF
Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair
  1. A L Knauth1,2,
  2. K Gauvreau1,
  3. A J Powell1,
  4. M J Landzberg1,2,
  5. E P Walsh1,
  6. J E Lock1,
  7. P J del Nido3,
  8. T Geva1
  1. 1
    Department of Cardiology, Children’s Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  2. 2
    Boston Adult Congenital Heart Disease Service, Children’s Hospital Boston, Departments of Pediatrics and Medicine, Harvard Medical School, Boston, Massachusetts, USA
  3. 3
    Department of Cardiovascular Surgery, Children’s Hospital Boston, Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
  1. Dr T Geva, Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA; tal.geva{at}cardio.chboston.org

Abstract

Background: Factors associated with impaired clinical status in a cross-sectional study of patients with repaired tetralogy of Fallot (TOF) have been reported previously.

Objectives: To determine independent predictors of major adverse clinical outcomes late after TOF repair in the same cohort during follow-up evaluated by cardiac magnetic resonance (CMR).

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 (a) death; (b) sustained ventricular tachycardia; and (c) increase in NYHA class to grade III or IV.

Results: 22 major adverse outcomes occurred in 18 patients (20.5%): death in 4, sustained ventricular tachycardia in 8, and increase in NYHA class in 10. Multivariate analysis identified right ventricular (RV) end-diastolic volume Z ⩾7 (odds 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 the receiver operator characteristic curve of 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.

Statistics from Altmetric.com

Footnotes

  • Competing interests: None.

  • Funding: This work was supported in part by the National Institutes of Health (NIH/NHLBI 1P50 HL074734–01; Drs Geva, Powell and del Nido)

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.