Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Int J Cardiol. 2019 Nov 15;295:1-6. doi: 10.1016/j.ijcard.2019.07.097. Epub 2019 Aug 1.
Myocardial strain has been shown to predict outcome in various cardiovascular diseases, including congenital heart diseases. The aim of this study was to evaluate the predictive value of cardiac magnetic resonance (CMR) feature-tracking derived strain parameters in repaired tetralogy of Fallot (rTOF) patients for developing ventricular tachycardia (VT) and deterioration of ventricular function.
Patients with rTOF who underwent CMR investigation were included. Strain and strain-rate of both ventricles were assessed using CMR feature tracking. The primary outcome was a composite of the occurrence of sustained VT or non-sustained VT requiring invasive therapy. The secondary outcome was analyzed in patients that underwent a second CMR after 1.5 to 3.5 years. Deterioration was defined as reduction (≥10%) in right ventricular (RV) ejection fraction, reduction (≥10%) in left ventricular (LV) ejection fraction or increase (≥30 mL/m) in indexed RV end-diastolic volume compared to baseline.
172 patients (median age 24.3 years, 54 patients <18 years) were included. Throughout a median follow-up of 7.4 years, 9 patients (4.5%) experienced the primary endpoint of VT. Multivariate Cox-regression analysis showed that LV systolic circumferential strain-rate was independently predictive of primary outcome (p = 0.023). 70 patients underwent a serial CMR, of whom 14 patients (20%) showed ventricular deterioration. Logistic regression showed no predictive value of strain and strain-rate parameters.
In patients with rTOF, LV systolic circumferential strain-rate is an independent predictor for the development of VT. Ventricular strain parameters did not predict deterioration of ventricular function in the studied population.
心肌应变已被证明可预测多种心血管疾病（包括先天性心脏病）的结局。本研究旨在评估心脏磁共振（CMR）特征追踪衍生应变参数在修复性法洛四联症（rTOF）患者中的预测价值，以预测室性心动过速（VT）和心室功能恶化的发生。
纳入接受 CMR 检查的 rTOF 患者。使用 CMR 特征追踪评估左右心室的应变和应变速率。主要结局是持续性 VT 或需要侵入性治疗的非持续性 VT 的发生复合事件。对接受 1.5 至 3.5 年后第二次 CMR 的患者进行了次要结局分析。恶化定义为与基线相比，右心室（RV）射血分数降低（≥10%）、左心室（LV）射血分数降低（≥10%）或 RV 舒张末期容积指数增加（≥30 毫升/米）。
共纳入 172 例患者（中位数年龄 24.3 岁，54 例<18 岁）。中位随访 7.4 年后，9 例（4.5%）患者发生 VT 的主要终点事件。多变量 Cox 回归分析显示，LV 收缩周向应变率是主要结局的独立预测因素（p=0.023）。70 例患者进行了系列 CMR，其中 14 例（20%）患者出现心室恶化。Logistic 回归显示应变和应变速率参数无预测价值。
在 rTOF 患者中，LV 收缩周向应变率是 VT 发生的独立预测因素。在研究人群中，心室应变参数不能预测心室功能恶化。
