Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2024
Prognostic value of myocardial deformation parameters for outcome prediction in tetralogy of Fallot.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Thomas Subin K, DSouza Romina, Hanneman Kate, Karur Gauri R, Houbois Christian, Ishikita Ayako, D'Errico Luigia, Begun Isaac, Ng Ming-Yen, Wald Rachel M
Аннотация
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.
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.
Предметные рубрики MeSH
HumansTetralogy of FallotMaleFemaleAdultPredictive Value of TestsVentricular Function, LeftVentricular Function, RightVentricular RemodelingMagnetic Resonance Imaging, CineRegistriesRisk FactorsPulmonary Valve InsufficiencyTreatment OutcomeMiddle AgedYoung AdultTime FactorsCardiac Surgical ProceduresRisk AssessmentRetrospective StudiesHeart Valve Prosthesis ImplantationMyocardial ContractionRecovery of Function