期刊
JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE
卷 24, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s12968-022-00877-x
关键词
Tetralogy of Fallot; Biventricular shape; Magnetic resonance imaging; Biomarker
资金
- National Institutes of Health (USA) [R01HL121754]
- Competence Network for Congenital Heart Defects from the Federal Ministry of Education and Research [01GI0601]
- DZHK (German Centre for Cardiovascular Research)
- W. B. & Ellen Gordon Stuart Trust
- Communities Foundation of Texas
- Pogue Family Distinguished Chair
- Wellcome Trust Senior Research Fellowship [209450/Z/17/Z]
- Informatics for Life - Klaus Tschira Foundation
This study found that adverse events in patients with repaired tetralogy of Fallot (rToF) are closely associated with pathological remodelling patterns. These patterns include a more circular left ventricle, dilated LV base, increased RV apical sphericity, and decreased RV basal sphericity.
Background Maladaptive remodelling mechanisms occur in patients with repaired tetralogy of Fallot (rToF) resulting in a cycle of metabolic and structural changes. Biventricular shape analysis may indicate mechanisms associated with adverse events independent of pulmonary regurgitant volume index (PRVI). We aimed to determine novel remodelling patterns associated with adverse events in patients with rToF using shape and function analysis. Methods Biventricular shape and function were studied in 192 patients with rToF (median time from TOF repair to baseline evaluation 13.5 years). Linear discriminant analysis (LDA) and principal component analysis (PCA) were used to identify shape differences between patients with and without adverse events. Adverse events included death, arrhythmias, and cardiac arrest with median follow-up of 10 years. Results LDA and PCA showed that shape characteristics pertaining to adverse events included a more circular left ventricle (LV) (decreased eccentricity), dilated (increased sphericity) LV base, increased right ventricular (RV) apical sphericity, and decreased RV basal sphericity. Multivariate LDA showed that the optimal discriminative model included only RV apical ejection fraction and one PCA mode associated with a more circular and dilated LV base (AUC = 0.77). PRVI did not add value, and shape changes associated with increased PRVI were not predictive of adverse outcomes. Conclusion Pathological remodelling patterns in patients with rToF are significantly associated with adverse events, independent of PRVI. Mechanisms related to incident events include LV basal dilation with a reduced RV apical ejection fraction.
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