Abstract | OBJECTIVE: Myocardial fibrosis has been associated with poorer outcomes in tetralogy of Fallot, however only a handful of studies have assessed its significance in the current era. Our aim was to quantify the amount of late gadolinium enhancement in both the LV and RV in a contemporary cohort of adults with surgically repaired tetralogy of Fallot, and assess the relationship with adverse clinical outcomes. DESIGN: Single centre cohort study SETTING: National tertiary referral center Patients: One hundred fourteen patients with surgically repaired tetralogy of Fallot with median age 29.5 years (range 17.5-64.2). Prospective follow-up for mean 2.4 years (SD 1.29). INTERVENTIONS: Cardiovascular magnetic resonance was performed, and late gadolinium enhancement mass was estimated for the LV using the 5-SD remote myocardium method, and for the RV using a segmental scoring system. Cohort characterization was determined through the use of a computerized database. OUTCOME MEASURES: RESULTS: Eleven patients experienced an adverse outcome in the follow-up period, although there were no deaths. LV late gadolinium enhancement was associated with adverse outcomes in a univariate model (P = .027). However, when adjusted for age at scan the significant variables included NYHA class (P = .006), peak oxygen uptake (P = .028), number of prior sternotomies (P = .044), and higher indexed RV and LV end diastolic volumes (P = .002 and P < .001), but not RV or LV late gadolinium enhancement. CONCLUSIONS: Formal quantification of late gadolinium enhancement is not currently as helpful in ascertaining prognosis compared to other, more easily assessed parameters in a contemporary cohort of tetralogy of Fallot survivors, however assessment particularly of the LV holds promise for the future.
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Authors | Richard J Dobson, Ify Mordi, Mark H Danton, Niki L Walker, Hamish A Walker, Nikolaos Tzemos |
Journal | Congenital heart disease
(Congenit Heart Dis)
Vol. 12
Issue 1
Pg. 58-66
(Jan 2017)
ISSN: 1747-0803 [Electronic] United States |
PMID | 27553872
(Publication Type: Journal Article)
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Copyright | © 2016 Wiley Periodicals, Inc. |
Chemical References |
- Contrast Media
- Organometallic Compounds
- Meglumine
- gadoterate meglumine
|
Topics |
- Adolescent
- Adult
- Arrhythmias, Cardiac
(diagnosis, etiology, therapy)
- Cardiac Surgical Procedures
(adverse effects)
- Contrast Media
- Defibrillators, Implantable
- Electric Countershock
(instrumentation)
- Female
- Fibrosis
- Follow-Up Studies
- Heart Failure
(diagnosis, etiology, therapy)
- Heart Ventricles
(abnormalities, diagnostic imaging, surgery)
- Hospitalization
- Humans
- Magnetic Resonance Imaging
- Male
- Meglumine
- Middle Aged
- Myocardium
(pathology)
- Organometallic Compounds
- Predictive Value of Tests
- Prospective Studies
- Risk Factors
- Scotland
- Survivors
- Tertiary Care Centers
- Tetralogy of Fallot
(diagnostic imaging, surgery)
- Time Factors
- Treatment Outcome
- Young Adult
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