Cardiac magnetic resonance parameters to predict ventricular arrhythmias inducibility before pulmonary valve replacement in patient with tetralogy of Fallot

IF 18 Q4 Medicine

Archives of Cardiovascular Diseases Supplements Pub Date : 2023-09-01 DOI:10.1016/j.acvdsp.2023.07.006

MD Grégoire Albenque , PhD, MD Francis Bessière , PhD, MD Gilles Soulat , MD Arshid Azarine , MD Mohamed Bakloul , MD Emre Belli , PhD, MD Damien Bonnet , PhD, MD Loic Boussel , MD Eric Bruguière , PhD, MD Sarah Cohen , MD Hubert Delasnerie , MD Sylvie Di Filippo , MD Arnaud Dulac , MD Kevin Gardey , MD Roland Henaine , MD Laurence Iserin , PhD, MD Clément Karsenty , PhD, MD Magalie Ladouceur , MD Antoine Legendre , MD Sophie Malekzadeh-Milani , PhD, MD Victor Waldmann

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Abstract

Introduction

Ventricular arrhythmias and sudden death are recognized complications of tetralogy of Fallot (TOF). Electrophysiological study (EPS) is increasingly performed prior to pulmonary valve replacement (PVR) in these patients to evaluate and treat the arrhythmic substrate.

Objective

We aimed to assess the value of cardiac magnetic resonance (CMR) to refine pre-operative risk stratification in this population.

Methods

A prospective multicenter study was conducted to systematically assess EPS in patients with TOF referred for PVR from January 2020 to December 2021. Multiple CMR parameters were analyzed and correlated with EPS results.

Results/Expected results

Among a total of 120 patients enrolled, 108 (90.0%) patients who had a CMR prior to EPS were analyzed. A VA was inducible in 24 (22.2%) patients. Clinical characteristics of patients associated with EPS results are presented in Table 1. Concerning CMR variables, mean RV end-diastolic volume index was 157 ± 39 ml and was not statistically different in patients with positive vs. negative EPS (164 ± 49 vs. 155 ± 35, P = 0.395). However, a RV/LV end-diastolic volume index ratio > 2.4 was significantly associated with a higher likelihood of inducibility (OR 3.10, 95%CI 1.14–8.74, P = 0.040). Mean RV end-systolic volume index tended to be upper in patient with positive EPS (101 ± 35 vs. 86 ± 26, P = 0.072). The RV ejection fraction measured on CMR also tended to be slightly lower in patients with positive EPS (40 ± 7 vs. 43 ± 9, P = 0.069) unlike the LV ejection fraction (P = 0.600). Mean pulmonary annulus diameter were also significantly associated with positive EPS (31 ± 8 vs. 26 ± 7 mm, OR 1.10 [1.02–1.18] per 1 mm increment, P = 0.012). A pulmonary annulus diameter > 28 mm was associated with an OR of 2.9 [1.10–8.11] (P = 0.047). In multivariable analysis, RV/LV end-diastolic volume index ratio > 2.4 (OR 4.6 [1.2–22.5], P = 0.036) and history of atrial arrhythmia (OR 10.9 [2.6–60.8], P = 0.002) remained independent predictors of VA inducibility (Figure 1).

Conclusion/Perspectives

In patients with TOF prior to PVR, RV/LV end-diastolic volume index ratio and pulmonary annulus diameter are associated with ventricular arrhythmia inducibility during EPS. CMR parameters, in combination with other clinical factors, may be useful to improve pre-operative risk stratification.

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心脏磁共振参数预测法洛四联症患者肺动脉瓣置换术前室性心律失常的诱发性

室性心律失常和猝死是法洛四联症(TOF)公认的并发症。越来越多的患者在肺瓣膜置换术(PVR)前进行电生理研究(EPS)，以评估和治疗心律失常的基底。目的评估心脏磁共振(CMR)技术在该人群术前风险分层中的应用价值。方法从2020年1月至2021年12月，进行一项前瞻性多中心研究，系统评估TOF患者的EPS。分析了多个CMR参数与EPS结果的相关性。结果/预期结果在总共120例入组患者中，分析了108例(90.0%)EPS前有CMR的患者。24例(22.2%)患者可诱导VA。EPS结果相关患者的临床特征见表1。在CMR变量方面，EPS阳性与阴性患者的平均左室舒张末期容积指数为157±39 ml，差异无统计学意义(164±49 vs 155±35,P = 0.395)。然而，右室/左室舒张末期容积指数比>2.4与较高的诱导可能性显著相关(OR 3.10, 95%CI 1.14-8.74, P = 0.040)。EPS阳性患者右心室收缩末期平均容积指数较高(101±35∶86±26,P = 0.072)。与左室射血分数(P = 0.600)不同，EPS阳性患者CMR测量的右室射血分数也略低(40±7比43±9,P = 0.069)。平均肺环直径也与EPS阳性显著相关(31±8 vs. 26±7 mm, OR为1.10 [1.02-1.18]/ 1 mm, P = 0.012)。A肺环直径;28 mm与OR为2.9[1.10-8.11]相关(P = 0.047)。在多变量分析中，左室/左室舒张末期容积指数比>2.4 (OR 4.6 [1.2-22.5]， P = 0.036)和心房心律失常史(OR 10.9 [2.6-60.8]， P = 0.002)仍然是室性心律失常诱发性的独立预测因子(图1)。结论/观点在PVR前TOF患者中，左室/左室舒张末期容积指数比和肺环直径与EPS期间室性心律失常的诱发性相关。CMR参数，结合其他临床因素，可能有助于改善术前风险分层。

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来源期刊

Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-

自引率

0.00%

发文量

508

期刊介绍： Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.