Department of Medical Imaging, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto General Hospital, 585 University Avenue, 1PMB-298, Toronto, Ontario M5G 2N2, Canada.
Division of Cardiology, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Eur Heart J Cardiovasc Imaging. 2018 Jul 1;19(7):777-784. doi: 10.1093/ehjci/jex248.
Our aims were to explore cardiac magnetic resonance quantification of myocardial extracellular volume (ECV) in adults with repaired tetralogy of Fallot (rTOF) when compared with healthy controls and to investigate the association between ECV and major adverse cardiovascular outcomes.
We prospectively recruited adults with rTOF (n = 44, 59% male, 32.9 ± 13.6 years) and evaluated right ventricular (RV) and left ventricular (LV) ECV by pre/post-gadolinium T1 measurements (modified Look-Locker inversion recovery technique) on a 1.5-T Siemens scanner compared with the healthy controls (n = 10, 50% male, 31.5 ± 4.4 years). The primary end point was a composite of death, out-of-hospital cardiac arrest, heart failure (HF) requiring admission for escalation of therapy, or haemodynamically significant ventricular tachycardia (VT) (lasting >30 s and/or resulting in invasive therapy). The association between ECV and adverse events was assessed using Cox proportional hazard models [median follow-up 236 days, interquartile range (IQR) 38-342]. RVECV was higher in patients compared with the controls (31.5 ± 5.4% vs. 26.3 ± 2.1%, P = 0.027). The following major adverse events occurred (n = 9, 21%): death (n = 1), out-of-hospital cardiac arrest (n = 1), HF (n = 1), and VT (n = 6). RVECV was higher among those with an adverse event compared to those without (35.0 ± 5.5% vs. 29.6 ± 4.5%, P = 0.014) and was associated with increased risk for adverse events [hazard ratio 1.13, 95% confidence interval (1.01-1.28); P = 0.037]. LVECV was not associated with adverse events (P = 0.667).
Increased RVECV is associated with adverse cardiovascular events in adults with rTOF. These results may lead to further studies exploring the potential role for RVECV in risk stratification and targeted therapeutic interventions in this population.
本研究旨在探索经修复的法洛四联症（rTOF）患者与健康对照者之间心脏磁共振定量心肌细胞外容积（ECV）的差异，并探讨 ECV 与主要不良心血管结局之间的关系。
我们前瞻性地招募了 rTOF 患者（n=44，59%为男性，年龄 32.9±13.6 岁），并在 1.5T 西门子扫描仪上通过钆增强前后 T1 测量（改良 Look-Locker 反转恢复技术）评估右心室（RV）和左心室（LV）ECV，同时纳入健康对照者（n=10，50%为男性，年龄 31.5±4.4 岁）。主要终点为死亡、院外心脏骤停、心力衰竭（HF）需要入院升级治疗或血流动力学显著室性心动过速（VT）（持续>30s 并/或需要侵入性治疗）的复合终点。采用 Cox 比例风险模型评估 ECV 与不良事件之间的关系[中位随访时间 236 天，四分位距（IQR）38-342]。与对照组相比，患者的 RVECV 更高（31.5±5.4%比 26.3±2.1%，P=0.027）。共有 9 例（21%）发生以下重大不良事件：死亡（n=1）、院外心脏骤停（n=1）、HF（n=1）和 VT（n=6）。与无不良事件者相比，发生不良事件者的 RVECV 更高（35.0±5.5%比 29.6±4.5%，P=0.014），并且 RVECV 与不良事件风险增加相关[风险比 1.13，95%置信区间（1.01-1.28）；P=0.037]。LVECV 与不良事件无关（P=0.667）。
RVECV 增加与 rTOF 患者的不良心血管事件相关。这些结果可能导致进一步研究探索 RVECV 在该人群风险分层和靶向治疗干预中的潜在作用。
