Riesenkampff Eugénie, Luining Wietske, Seed Mike, Chungsomprasong Paweena, Manlhiot Cedric, Elders Bernadette, McCrindle Brian W, Yoo Shi-Joon, Grosse-Wortmann Lars
Department of Pediatrics, Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
J Cardiovasc Magn Reson. 2016 Oct 26;18(1):75. doi: 10.1186/s12968-016-0290-x.
Unfavorable left ventricular (LV) remodelling may be associated with adverse outcomes after Tetralogy of Fallot (TOF) repair. We sought to assess T1 cardiovascular magnetic resonance (CMR) markers of diffuse LV myocardial fibrosis in children after TOF repair, and associated factors.
In this prospective, cross-sectional study, native (=non-contrast) T1 times and extracellular volume fraction (ECV) were quantified in the LV myocardium using CMR. Results were related to ventricular volumes and function, degree of pulmonary regurgitation, as well as surgical characteristics, and exercise capacity.
There was no difference in native T1 times or ECV between 31 TOF patients (age at CMR 13.9 ± 2.4 years, 19 male) and 15 controls (age at CMR 13.4 ± 2.6 years, 7 male). Female TOF patients had higher ECVs than males (25.2 ± 2.9 % versus 22.7 ± 3.3 %, p < 0.05). In the patient group, higher native T1 and ECV correlated with higher Z-Scores of right and left ventricular end-diastolic volumes, but not with reduced left and right ventricular ejection fraction or higher pulmonary regurgitation fraction. Longer cardiopulmonary bypass and aortic cross clamp times at surgery correlated with increased native T1 times and ECVs (r = 0.48, p < 0.05 and r = 0.65, p < 0.01, respectively). Maximum workload (percent of predicted for normal) correlated inversely with ECV (r = -0.62, p < 0.05). Higher native T1 times correlated with worse LV longitudinal (r = 0.50, p < 0.05) and mid short axis circumferential strain (r = 0.38, p < 0.05).
As compared to controls, TOF patients did not express higher markers of diffuse fibrosis. Longer cardiopulmonary bypass and aortic cross clamp times at surgery as well as biventricular enlargement and reduced exercise tolerance are associated with markers of diffuse myocardial fibrosis after TOF repair. Female patients have higher markers of diffuse myocardial fibrosis than males.
法洛四联症（TOF）修复术后左心室（LV）重塑不良可能与不良预后相关。我们旨在评估TOF修复术后儿童弥漫性左心室心肌纤维化的T1心血管磁共振（CMR）标志物及相关因素。
在这项前瞻性横断面研究中，使用CMR对左心室心肌的固有（即非对比）T1时间和细胞外容积分数（ECV）进行定量。结果与心室容积和功能、肺反流程度、手术特征以及运动能力相关。
31例TOF患者（CMR检查时年龄13.9±2.4岁，男性19例）与15例对照组（CMR检查时年龄13.4±2.6岁，男性7例）之间的固有T1时间或ECV无差异。女性TOF患者的ECV高于男性（25.2±2.9%对22.7±3.3%，p<0.05）。在患者组中，较高的固有T1和ECV与右心室和左心室舒张末期容积的较高Z值相关，但与左心室和右心室射血分数降低或较高的肺反流分数无关。手术时较长的体外循环和主动脉阻断时间与固有T1时间和ECV增加相关（r分别为0.48，p<0.05和r为0.65，p<0.01）。最大工作量（正常预测值的百分比）与ECV呈负相关（r=-0.62，p<0.05）。较高的固有T1时间与较差的左心室纵向应变（r=0.50，p<0.05）和中短轴圆周应变（r=0.38，p<0.05）相关。
与对照组相比，TOF患者未表现出更高的弥漫性纤维化标志物。手术时较长的体外循环和主动脉阻断时间以及双心室扩大和运动耐量降低与TOF修复术后弥漫性心肌纤维化标志物相关。女性患者的弥漫性心肌纤维化标志物高于男性。
