Prognostic value of myocardial deformation parameters for outcome prediction in tetralogy of Fallot.

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Subin K Thomas, Romina DSouza, Kate Hanneman, Gauri R Karur, Christian Houbois, Ayako Ishikita, Luigia D'Errico, Isaac Begun, Ming-Yen Ng, Rachel M Wald
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引用次数: 0

Abstract

Background: The prognostic value of myocardial deformation parameters in adults with repaired tetralogy of Fallot (rTOF) has not been well-elucidated. We therefore aimed to explore myocardial deformation parameters for outcome prediction in adults with rTOF using cardiovascular magnetic resonance imaging (CMR).

Methods: Adults with rTOF and at least moderate pulmonary regurgitation were identified from an institutional prospective CMR registry. Left ventricular (LV) and right ventricular (RV) global strains were recorded in longitudinal (GLS), circumferential (GCS), and radial (GRS) directions. Major adverse cardiovascular events (MACE) were defined as a composite of mortality, resuscitated sudden death, sustained ventricular tachycardia (>30 seconds), or heart failure (hospital admission >24 hours). In patients with pulmonary valve replacement (PVR), pre- and post-PVR CMR studies were analyzed to assess for predictors of complete RV reverse remodeling, defined as indexed RV end-diastolic volume (RVEDVi) <110 mL/m2. Logistic regression models were used to estimate the odds ratio (OR) per unit change in absolute strain value associated with clinical outcomes and receiver operator characteristic curves were constructed with area under the curve (AUC) for select CMR variables.

Results: We included 307 patients (age 35 ± 13 years, 59% (180/307) male). During 6.1 years (3.3-8.8) of follow-up, PVR was performed in 142 (46%) and MACE occurred in 31 (10%). On univariate analysis, baseline biventricular ejection fraction (EF), mass, and all strain parameters were associated with MACE. After adjustment for LVEF, only LV-GLS remained independently predictive of MACE (OR 0.822 [0.693-0.976] p = 0.025). Receiver operator curves identified an absolute LV-GLS value less than 15 and LVEF less than 51% as thresholds for MACE prediction (AUC 0.759 [0.655-0.840] and 0.720 [0.608-0.810]). After adjusting for baseline RVEDVi, RV-GCS (OR 1.323 [1.094-1.600] p = 0.004), LV-GCS (OR 1.276 [1.029-1.582] p = 0.027) and LV-GRS (OR 1.101 [1.0210-1.200], p = 0.028) were independent predictors of complete remodeling post-PVR remodeling.

Conclusion: Biventricular strain parameters predict clinical outcomes and post-PVR remodeling in rTOF. Further study will be necessary to establish the role of myocardial deformation parameters in clinical practice.

心肌变形参数对法洛氏四联症预后的预测价值。
导言:法洛氏四联症(rTOF)成人患者心肌变形参数的预后价值尚未得到很好的阐明。因此,我们的目的是利用心血管磁共振成像(CMR),探讨心肌变形参数对成人法洛氏四联症患者预后的预测作用:方法:我们从一家机构的前瞻性 CMR 登记处找到了患有 rTOF 和至少中度肺动脉反流(PR)的成人。从纵向(GLS)、环向(GCS)和径向(GRS)三个方向记录左心室(LV)和右心室(RV)的整体应变。主要不良心血管事件(MACE)定义为死亡率、复苏后猝死、持续室性心动过速(>30 秒)或心力衰竭(入院时间>24 小时)的综合结果。对肺动脉瓣置换术(PVR)患者进行PVR前后CMR研究分析,以评估RV完全反向重塑的预测因素,我们将其定义为RV舒张末期容积指数(RVEDVi):我们共纳入了 307 名患者(年龄为 35±13 岁,59% 为男性)。在 6.1 年(3.3-8.8 年)的随访期间,142 名患者(46%)进行了肺动脉瓣置换术(PVR),31 名患者(10%)发生了 MACE。单变量分析显示,基线双心室射血分数(EF)、质量和所有应变参数都与MACE有关。调整 LVEF 后,只有 LVGLS 仍可独立预测 MACE(OR 0.822 [0.693-0.976] p=0.025)。接收器运算曲线确定了 LVGLS 绝对值小于 15 和 LVEF 结论:双心室应变参数可预测 rTOF 的临床预后和 PVR 后的重塑。有必要进行进一步研究,以确定心肌变形参数在临床实践中的作用。
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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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