RT Journal Article
SR Electronic
T1 Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 855
OP 863
DO 10.1136/heartjnl-2018-313961
VO 105
IS 11
A1 Kenichiro Yamamura
A1 Darren Yuen
A1 Edward J Hickey
A1 Xiaolin He
A1 Rajiv R Chaturvedi
A1 Mark K Friedberg
A1 Lars Grosse-Wortmann
A1 Kate Hanneman
A1 Filio Billia
A1 Michael E Farkouh
A1 Rachel M Wald
YR 2019
UL http://heart.bmj.com/content/105/11/855.abstract
AB Objective The relationship between right ventricular (RV) fibrosis and right heart reverse remodelling following pulmonary valve replacement (PVR) has not been well studied in adults with repaired tetralogy of Fallot (rTOF). Our aims were to histologically quantify RV fibrosis and to explore the relationship between fibrosis severity and cardiac remodelling post-PVR.Methods Adults with rTOF and pre-PVR cardiovascular (CMR) imaging were consented to procurement of RV muscle during PVR. Samples were stained with picrosirius red to quantify collagen volume fraction. Clinical data at baseline and at last follow-up were reviewed. Adverse cardiovascular outcomes included death, sustained arrhythmia and heart failure.Results Fifty-three patients (male 58%, 38±11 years) were studied. Those with severe fibrosis (collagen volume fraction >11.0%, n=13) had longer aortic cross-clamp times at initial repair compared with the remainder of the population (50 vs 33 min, p=0.018) and increased RV mass:volume ratio pre-PVR (0.20 vs 0.18 g/mL, p=0.028). Post-PVR, the severe fibrosis group had increased indexed RV end-systolic volume index (RVESVi) (74 vs 66 mL/m2, p=0.044), decreased RVESVi change (Δ29 vs Δ45 mL/m2, p=0.005), increased RV mass (34 vs 25 g/m2, p=0.023) and larger right atrial (RA) area (21 vs 17 cm2, p=0.021). A trend towards increased heart failure events was observed in the severe fibrosis group (15% vs 0%, p=0.057).Conclusions Severe RV fibrosis was associated with increased RVESVi, RV mass and RA area post-PVR in rTOF. Further study is required to define the impact of fibrosis and persistent right heart enlargement on clinical outcomes.