Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan; Section of Pediatric Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan.
Am J Cardiol. 2014 Mar 15;113(6):1031-5. doi: 10.1016/j.amjcard.2013.11.067. Epub 2013 Dec 25.
Patients with tetralogy of Fallot (TOF) have abnormal aortic properties. It is not known if this increases the risk for aneurysm formation. We sought to identify clinical and cardiovascular magnetic resonance (CMR) imaging patient characteristics associated with worsened aortic pulse wave velocity (PWV) and aortic strain in patients with repaired TOF. In 124 patients with TOF undergoing CMR (median age 24.6 years, interquartile range 17.8 to 34.2), left and right ventricular volumetric data, aortic PWV, and aortic strain were evaluated. Increased PWV positively correlated with age at repair (r = 0.3, p = 0.001) and cross-sectional ascending aortic area (r = 0.34, p <0.001) and was associated with a history of shunt placement (p = 0.01). Decreased aortic strain also correlated with age at TOF repair (r = -0.5, p <0.001), cross-sectional ascending aortic area (r = -0.43, p <0.001), aortic regurgitation (r = -0.46, p ≤0.001), and history of shunt placement (p <0.001). In a multivariate regression model controlling for history of shunt placement, use of cardiac medication, and aortic regurgitation, age at CMR was significantly associated with PWV (p = 0.005), whereas age at repair trended toward significance (p = 0.06). In conclusion, patients with TOF have abnormal aortic properties correlated with greater age, which may be associated with later repair. Longitudinal data are necessary to assess the risk of aortic aneurysm and dissection as the TOF population grows older. Functional imaging of the aorta by CMR may be useful in predicting risk and assessing vascular health.
法洛四联症（TOF）患者的主动脉性质异常。目前尚不清楚这是否会增加动脉瘤形成的风险。我们试图确定与修复后的 TOF 患者的主动脉脉搏波速度（PWV）和主动脉应变恶化相关的临床和心血管磁共振（CMR）成像患者特征。在 124 名接受 CMR 的 TOF 患者中（中位年龄 24.6 岁，四分位间距 17.8 至 34.2），评估了左、右心室容积数据、主动脉 PWV 和主动脉应变。增加的 PWV 与修复时的年龄呈正相关（r = 0.3，p = 0.001）和升主动脉截面积（r = 0.34，p <0.001），与分流器放置史相关（p = 0.01）。主动脉应变的减少也与 TOF 修复时的年龄（r = -0.5，p <0.001）、升主动脉截面积（r = -0.43，p <0.001）、主动脉瓣反流（r = -0.46，p ≤0.001）和分流器放置史相关（p <0.001）。在控制分流器放置史、心脏药物使用和主动脉瓣反流的多变量回归模型中，CMR 时的年龄与 PWV 显著相关（p = 0.005），而修复时的年龄呈趋势（p = 0.06）。总之，TOF 患者的主动脉性质异常与年龄较大相关，这可能与较晚的修复有关。需要进行纵向数据评估随着 TOF 人群年龄的增长，主动脉瘤和夹层的风险。CMR 对主动脉的功能成像可能有助于预测风险和评估血管健康。
