Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair
Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair
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DOI：
10.1136/hrt.2006.104745
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发表时间：
2008-02-01
期刊：
影响因子：
5.7
通讯作者：
Geva, T.
中科院分区：
文献类型：
--
作者：
Knauth, A. L.;Gauvreau, K.;Geva, T.
背景：在一项对修复性法洛四联症（TOF）患者的横断面研究中，与临床状态受损相关的因素已经有报道。目的：在心脏磁共振（CMR）随访期间，确定同一队列TOF修复后晚期主要不良临床结局的独立预测因素。方法：确定88例患者最新随访时的临床状况（从TOF修复到基线评估的中位时间为20.7年；从基线评估到最近随访的中位时间为4.2年）。主要不良后果包括：(a)死亡；(b)持续性室性心动过速；结果：18例（20.5%）患者发生了22个主要不良结局：4例死亡，8例持续室性心动过速，10例NYHA分级增加。多因素分析发现，右心室（RV）舒张末期容积z> = 7(优势比（OR)= 4.55, 95%可信区间（CI） 1.10 ~ 18.8, p= 0.037）和左心室（LV）射血分数< 55% （OR= 8.05, 95% CI 2.14 ~ 30.2, p= 0.002）是预后的独立预测因子，受体操作者特征曲线下面积为0.850。在多变量模型中，左室射血分数< 45%可以代替左室射血分数。QRS持续时间>= 180 ms也可预测主要不良事件，但与RV大小相关。结论：在该队列中，CMR评估的严重左室扩张和左室或右室功能障碍预测了主要的不良临床事件。这些信息可以指导风险分层和治疗干预。
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.