Takahashi Tatsunori, Shiina Yumi, Nagao Michinobu, Inai Kei
Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan.
Department of Pediatrics, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, Yamagata, 990-9585, Japan.
Heart Vessels. 2019 Jan;34(1):114-122. doi: 10.1007/s00380-018-1217-2. Epub 2018 Jul 4.
The prognostic factors in patients with biventricular heart who underwent Fontan surgery remain unclear. This study wanted to assess the hypothesis that interventricular dyssynchrony evaluated by cardiac magnetic resonance imaging (MRI) can predict future cardiac events in patients with biventricular heart who have undergone Fontan surgery. We prospectively enrolled consecutive patients with biventricular Fontan circulation from 2003 to 2016, and performed protocolized cardiac MRI. We determined the stroke volume ratio (SVr) using the following formula to assess interventricular dyssynchrony: (stroke volume (SV) of the two whole ventricles)/(SV of the right ventricle + SV of the left ventricle), by tracing cine MRI data. If interventricular dyssynchrony existed, blood flowed and returned to each ventricle through the ventricular septal defect; therefore, the SVr in this instance should be less than 1.0. We enrolled 40 patients. SVr ranged from 0.81 to 1.0 (median 0.95). Low SVr (< 0.95) was associated with worse New York Heart Association functional class, longer QRS duration, right bundle branch block, low biventricular indexed stroke volume, and low biventricular ejection fraction. During the follow-up period (median 53.5 months), 10 cardiac events occurred (six cases of acute exacerbation of heart failure, three cases of supraventricular tachycardia, and one case of exacerbation of protein-losing enteropathy). Univariate analysis showed four clinical predictors: SVr < 0.95 [hazard ratio (HR) 9.3, 95% confidential interval (CI) 1.7-171.5]; biventricular ejection fraction < 0.45 (HR 9.4, 95% CI 2.2-65.3); left ventricular indexed end-diastolic volume > 73 mL/m (HR 4.5, 95% CI 1.1-15.7); and the presence of the aorta directly arising from the right ventricular conus (HR 5.8, 95% CI 1.1-106). SVr derived from MRI can predict future cardiac events in Fontan patients with biventricular hearts.
接受Fontan手术的双心室心脏患者的预后因素仍不清楚。本研究旨在评估以下假设：通过心脏磁共振成像（MRI）评估的心室间不同步可预测接受Fontan手术的双心室心脏患者未来的心脏事件。我们前瞻性地纳入了2003年至2016年连续的双心室Fontan循环患者，并进行了标准化的心脏MRI检查。我们使用以下公式确定每搏量比（SVr）以评估心室间不同步：（两个全心室的每搏量（SV））/（右心室SV + 左心室SV），通过追踪电影MRI数据得出。如果存在心室间不同步，血液会通过室间隔缺损流入并返回每个心室；因此，这种情况下的SVr应小于1.0。我们纳入了40例患者。SVr范围为0.81至1.0（中位数0.95）。低SVr（<0.95）与纽约心脏协会功能分级较差、QRS时限延长、右束支传导阻滞、双心室指数化每搏量低以及双心室射血分数低有关。在随访期间（中位数53.5个月），发生了10次心脏事件（6例心力衰竭急性加重、3例室上性心动过速和1例蛋白丢失性肠病加重）。单因素分析显示了四个临床预测因素：SVr < 0.95 [风险比（HR）9.3，95%置信区间（CI）1.7 - 171.5]；双心室射血分数 < 0.45（HR 9.4，95% CI 2.2 - 65.3）；左心室指数化舒张末期容积 > 73 mL/m（HR 4.5, 95% CI 1.1 - 15.7）；以及主动脉直接起源于右心室圆锥部（HR 5.8, 95% CI 1.1 - 106）。源自MRI的SVr可预测双心室Fontan患者未来的心脏事件。
