Pettit Kevin A, Francois Christopher J, Aggarwal Niti R, Hess Timothy M, Bartlett Heather L
Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, USA.
Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, USA.
Pediatr Cardiol. 2019 Oct;40(7):1530-1535. doi: 10.1007/s00246-019-02181-5. Epub 2019 Aug 10.
The timing of pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) is typically based on cardiac magnetic resonance imaging-derived ventricular volume measurements. Current criteria do not account for sex-based differences in chamber size. The purpose of this study was to compare male and female ventricular volumes and function in TOF patients with a hypothesis that females are less likely to meet common-indexed right ventricular end-diastolic volume (RVEDVi) and right ventricular end-systolic volume (RVESVi) criteria for PVR. Cardiac magnetic resonance data from 17 females (age 31.7 ± 15.4 years) and 23 males (30.7 ± 15.4 years) with TOF were retrospectively analyzed. Demographic and imaging data were recorded. Differences in sex-based means and standard deviations were evaluated using the Wilcoxon rank-sum test with continuity correction. Age and pulmonary regurgitant fraction were similar in females and males. RVEDVi was lower in females than in males, but the difference was not statistically significant. Differences in RVESVi, LVEDVi, LVESVi, and left ventricular ejection fraction were statistically significant, while the difference in right ventricular ejection fraction was not. RVEDVi was greater than 150 mL/m in 3/17 (17.6%) females and 10/23 (43.5%) males (OR 3.6). RVESVi was greater than 82 mL/m in 2/17 females and 8/23 males (OR 4.0). Sex-specific differences in right ventricular and left ventricular volumes and function are present in patients with TOF despite similar pulmonary regurgitation. These differences may need to be considered when evaluating patients for PVR.
法洛四联症（TOF）修复术后无症状患者的肺动脉瓣置换（PVR）时机通常基于心脏磁共振成像得出的心室容积测量结果。目前的标准未考虑腔室大小的性别差异。本研究的目的是比较TOF患者的男性和女性心室容积及功能，假设女性达到PVR常见指标右心室舒张末期容积（RVEDVi）和右心室收缩末期容积（RVESVi）标准的可能性较小。对17名女性（年龄31.7±15.4岁）和23名男性（30.7±15.4岁）TOF患者的心脏磁共振数据进行回顾性分析。记录人口统计学和影像学数据。使用连续性校正的Wilcoxon秩和检验评估基于性别的均值和标准差差异。女性和男性的年龄及肺动脉反流分数相似。女性的RVEDVi低于男性，但差异无统计学意义。RVESVi、左心室舒张末期容积（LVEDVi）、左心室收缩末期容积（LVESVi）和左心室射血分数的差异具有统计学意义，而右心室射血分数的差异无统计学意义。3/17（17.6%）的女性和10/23（43.5%）的男性RVEDVi大于150 mL/m²（比值比3.6）。2/17的女性和8/23的男性RVESVi大于82 mL/m²（比值比4.0）。尽管肺动脉反流相似，但TOF患者的右心室和左心室容积及功能存在性别差异。在评估患者是否适合PVR时可能需要考虑这些差异。
