Yim Deane, Riesenkampff Eugenie, Caro-Dominguez Pablo, Yoo Shi-Joon, Seed Mike, Grosse-Wortmann Lars
From the Division of Pediatric Cardiology, Department of Pediatrics (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.) and Department of Diagnostic Imaging (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Circ Cardiovasc Imaging. 2017 Mar;10(3). doi: 10.1161/CIRCIMAGING.116.005695.
Myocardial fibrosis is linked with adverse clinical outcomes in adults after tetralogy of Fallot repair (rTOF). Native T1 times (T1) by cardiac magnetic resonance have been shown to be a surrogate marker of diffuse myocardial fibrosis. The objective was to quantify native T1 in children post-rTOF and to evaluate their relationship with surgical, imaging, and clinical factors.
A retrospective cross-sectional study was performed. Midventricular native T1 were obtained in 100 children post-rTOF using a modified look-locker inversion recovery cardiac magnetic resonance sequence and compared with 35 pediatric controls. rTOF patients, aged 13.0±2.9 years, had higher indexed right ventricular (RV) end-diastolic (range 85-326 mL/m, mean 148 mL/m) volumes, and lower RV and left ventricular (LV) ejection fractions compared with controls. RV, but not LV, T1 were higher in patients than in controls (1031±74 versus 954±32 ms, <0.001) and female patients had higher RV T1 compared with males (1051±79 versus 1017±68 ms, =0.02). LV T1 correlated with RV T1 (=0.45, <0.001), cardiopulmonary bypass (=0.30, =0.007), and aortic cross-clamp times (=0.32, =0.004). RV T1 correlated inversely with RV outflow tract gradient (=-0.28, =0.02). Longer aortic cross-clamp times were independently associated with LV and RV T1 on multivariable analysis. There was no association between exercise intolerance, arrhythmia, and native T1 or LV extracellular volume.
Children after rTOF do not have elevated LV native T1 or LV extracellular volume, but show evidence of increased RV native T1 suggestive of diffuse RV fibrosis, for which volume loading seems to be a risk factor. Surgical bypass and cross-clamp times are associated with fibrotic remodeling over a decade later.
法洛四联症修复术后（rTOF）成人患者的心肌纤维化与不良临床结局相关。心脏磁共振成像的固有T1时间（T1）已被证明是弥漫性心肌纤维化的替代标志物。目的是量化rTOF术后儿童的固有T1，并评估其与手术、影像学和临床因素的关系。
进行了一项回顾性横断面研究。使用改良的锁相环反转恢复心脏磁共振序列，对100例rTOF术后儿童获取心室中部固有T1，并与35例儿科对照进行比较。rTOF患者年龄为13.0±2.9岁，与对照组相比，其右心室（RV）舒张末期容积指数更高（范围85-326 mL/m，平均148 mL/m），RV和左心室（LV）射血分数更低。患者的RV而非LV的T1高于对照组（1031±74对954±32 ms，P<0.001），女性患者的RV T1高于男性（1051±79对1017±68 ms，P=0.02）。LV T1与RV T1相关（r=0.45，P<0.001）、与体外循环相关（r=0.30，P=0.
