Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
University Heart Center, University Hospital Basel, Basel, Switzerland.
Open Heart. 2024 Jan 18;11(1):e002583. doi: 10.1136/openhrt-2023-002583.
Residual sequelae after surgical repair of tetralogy of Fallot (rTOF) affect clinical outcome. We investigated the prognostic impact of right ventricular (RV) dyssynchrony in adults with rTOF years after the surgical repair.
Patients from the Swiss Adult Congenital HEart disease Registry were included. NT-proBNP levels, echocardiography, exercise testing and MRI data were collected. An offline strain analysis to quantify RV-ventricular and interventricular dyssynchrony was performed. The standard deviation of the time-to-peak shortening (TTP) of six RV segments defined the RV Dyssynchrony Index (RVDI). Maximal difference of TTP between RV and left ventricular segments defined the interventricular shortening delay (IVSD). Predictors of a composite adverse event (arrhythmias, hospitalisation for heart failure and death) were identified by multivariate Cox regression analysis. Their median values were used to create a risk score.
Out of 285 included patients (mean age 34±14 years), 33 patients (12%) experienced an adverse event during a mean follow-up of 48±21 months. No correlation was found between RVDI, IVSD and clinical events. NT-proBNP, right atrial area and peak heart rate were independent predictors of outcomes. After 4 years-follow-up, no adverse events occurred in patients at low risk (score=0 points), while an adverse event occurred in 62% of patients at high risk (score=3 points, p<0.001).
In our cohort of adults with rTOF, surrogates of RV dyssynchrony did not correlate with outcomes. A multimodality approach was effective in predicting the risk for adverse events.
法洛四联症（TOF）手术后的残余后遗症会影响临床结果。我们研究了 TOF 手术后数年的右心室（RV）不同步对成年人的预后影响。
纳入了瑞士成人先天性心脏病注册中心的患者。收集了 NT-proBNP 水平、超声心动图、运动试验和 MRI 数据。进行了离线应变分析，以量化 RV-心室和室间不同步。六个 RV 节段的峰值缩短时间（TTP）标准差定义了 RV 不同步指数（RVDI）。RV 和左心室节段之间的 TTP 最大差异定义了室间缩短延迟（IVSD）。通过多变量 Cox 回归分析确定了复合不良事件（心律失常、心力衰竭住院和死亡）的预测因子。使用中位数创建风险评分。
在 285 名纳入的患者中（平均年龄 34±14 岁），33 名患者（12%）在平均 48±21 个月的随访中经历了不良事件。RVDI、IVSD 与临床事件之间无相关性。NT-proBNP、右心房面积和峰值心率是结局的独立预测因子。在 4 年的随访中，低危（评分=0 分）患者无不良事件发生，而高危（评分=3 分）患者中有 62%发生了不良事件（p<0.001）。
在我们的 TOF 成年患者队列中，RV 不同步的替代指标与结局无关。多模态方法在预测不良事件风险方面是有效的。
