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  • Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair

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Congenital heart disease
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.

https://doi.org/10.1136/hrt.2006.104745

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    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)