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.
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