Thomas P. Graham Division of Pediatric Cardiology Monroe Carell Jr Children's Hospital at Vanderbilt University, 2200 Children's Way Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA.
J Cardiovasc Magn Reson. 2023 Mar 13;25(1):17. doi: 10.1186/s12968-023-00928-x.
Patients with repaired Tetralogy of Fallot (rTOF) experience a high burden of long-term morbidity, particularly arrhythmias. Cardiovascular magnetic resonance (CMR) is routinely used to assess ventricular characteristics but the relationship between CMR diastolic function and arrhythmia has not been evaluated. We hypothesized in rTOF, left ventricular (LV) diastolic dysfunction on CMR would correlate with arrhythmias and mortality.
Adolescents and adults with rTOF who underwent CMR were compared to healthy controls (n = 58). Standard ventricular parameters were assessed and manual planimetry was performed to generate filling curves and indices of diastolic function. Chart review was performed to collect outcomes. Univariate and multivariable logistic regression was performed to identify outcome associations.
One-hundred sixty-seven subjects with rTOF (mean age 32 years) and 58 healthy control subjects underwent CMR. Patients with rTOF had decreased LV volumes and increased right ventricular (RV) volumes, lower RV ejection fraction (RVEF), lower peak ejection rate (PER), peak filling rate (PFR) and PFR indexed to end-diastolic volume (PFR/EDV) compared to healthy controls. Eighty-three subjects with rTOF had arrhythmia (63 atrial, 47 ventricular) and 11 died. Left atrial (LA) volumes, time to peak filling rate (tPFR), and PFR/EDV were associated with arrhythmia on univariate analysis. PER/EDV was associated with ventricular (Odds ratio, OR 0.43 [0.24-0.80], p = 0.007) and total arrhythmia (OR 0.56 [0.37-0.92], p = 0.021) burden. A multivariable predictive model including diastolic covariates showed improved prediction for arrhythmia compared to clinical and conventional CMR measures (area under curve (AUC) 0.749 v. 0.685 for overall arrhythmia). PFR/EDV was decreased and tPFR was increased in rTOF subjects with mortality as compared to those without mortality.
Subjects with rTOF have abnormal LV diastolic function compared to healthy controls. Indices of LV diastolic function were associated with arrhythmia and mortality. CMR diastolic indices may be helpful in risk stratification for arrhythmia.
患有修复性法洛四联症（rTOF）的患者长期患有较高的发病率，尤其是心律失常。心血管磁共振（CMR）通常用于评估心室特征，但 CMR 舒张功能与心律失常之间的关系尚未得到评估。我们假设，在 rTOF 中，CMR 上的左心室（LV）舒张功能障碍与心律失常和死亡率相关。
比较了接受 CMR 检查的 rTOF 青少年和成年人与健康对照组（n=58）。评估了标准心室参数，并进行手动平面测量以生成充盈曲线和舒张功能指数。进行图表审查以收集结果。进行单变量和多变量逻辑回归以确定结果相关性。
167 例 rTOF 患者（平均年龄 32 岁）和 58 例健康对照组接受了 CMR。rTOF 患者的 LV 容积减小，RV 容积增加，RV 射血分数（RVEF）降低，峰值射流率（PER）、峰值充盈率（PFR）和 PFR 与 EDV 的比值（PFR/EDV）降低。83 例 rTOF 患者有心律失常（63 例房性，47 例室性），11 例死亡。左心房（LA）容积、达峰充盈率时间（tPFR）和 PFR/EDV 在单变量分析中与心律失常相关。PER/EDV 与室性心律失常（优势比，OR 0.43[0.24-0.80]，p=0.007）和总心律失常（OR 0.56[0.37-0.92]，p=0.021）负担相关。包括舒张变量的多变量预测模型显示，与临床和常规 CMR 测量相比，心律失常的预测得到改善（整体心律失常的 AUC 为 0.749 与 0.685）。与无死亡的 rTOF 患者相比，有死亡的 rTOF 患者的 PFR/EDV 降低，tPFR 升高。
与健康对照组相比，rTOF 患者的 LV 舒张功能异常。LV 舒张功能指数与心律失常和死亡率相关。CMR 舒张指数可能有助于心律失常的危险分层。
