Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging
Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging
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DOI：
10.1016/j.jacc.2003.10.045
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发表时间：
2004-03-17
影响因子：
24
通讯作者：
Powell, AJ
中科院分区：
文献类型：
--
作者：
Geva, T;Sandweiss, BM;Powell, AJ
目的：本研究的目的是确定与法洛四联症（TOF）修复晚期幸存者临床状态受损相关的独立因素。背景：TOF的修复经常导致慢性肺反流（PR）和右心室（RV）扩张，这与晚期发病率和死亡率有关。然而，TOF修复后临床状态的决定因素尚未完全确定。方法对100例连续完成心脏磁共振成像方案的TOF修复患者（中位修复后21年）的临床和实验室资料进行分析。临床状态受损定义为纽约心脏协会（NYHA）功能等级大于或等于III级。结果患者NYHA功能I、II级88例，NYHA功能III级12例。PR度和右心室舒张末容积指数与临床状态不相关。通过多因素分析，较低的左室射血分数（EF）（下降10%时的比值比[OR] = 3.88, p = 0.002）和TOF修复时的年龄较大（上升5年时的比值比[OR] = 1.70, p = 0.013）是与临床状况受损相关的最强独立因素。在RV变量中，较低的RV EF是与临床状况较差相关的最强独立因素（OR = 2.41, p = 0.01）。左室EF与右室EF相关（r = 0.58, p < 0.001）。结论：中度或重度左室或右室收缩功能障碍与TOF修复术后长期存活患者的临床状况受损独立相关，而与PR分数或右室舒张尺寸无关。左室EF和右室EF的密切关系提示心室相互作用不利。
OBJECTIVES The purpose of this study was to identify independent factors associated with impaired clinical status in late survivors of tetralogy of Fallot (TOF) repair.BACKGROUND Repair of TOF often results in chronic pulmonary regurgitation (PR) and right ventricular (RV) dilation, which have been linked to late morbidity and mortality. However, determinants of clinical status late after TOF repair have not been fully characterized. METHODS The clinical and laboratory data of 100 consecutive patients with repaired TOF (median 21 years after repair) who completed a cardiac magnetic resonance imaging protocol were analyzed. Impaired clinical status was defined as New York Heart Association (NYHA) functional class greater than or equal to III.RESULTS Of the patients, 88 were in NYHA functional class I or II and 12 were in NYHA functional class III. The degree of PR and indexed RV end-diastolic volume were not associated with impaired clinical status. By multivariate analysis, a lower left ventricular (LV) ejection fraction (EF) (odds ratio [OR] = 3.88 for 10% decrease, p = 0.002) and older age at TOF repair (OR = 1.70 for 5-year increase, p = 0.013) were the strongest independent factors associated with impaired clinical status. Among RV variables, a lower RV EF was the strongest independent factors associated with poor clinical status (OR = 2.41 for 10% decrease, p = 0.01). The LV EF correlated with RV EF (r = 0.58, p < 0.001).CONCLUSIONS Moderate or severe LV or RV systolic dysfunction, but not PR fraction or RV diastolic dimensions, is independently associated with impaired clinical status in long-term survivors of TOF repair. The close relationship between LV EF and RV EF suggests unfavorable ventricular ventricular interaction.