학술논문
The Prognostic Value of Myocardial Deformation in Adult Patients With Corrected Tetralogy of Fallot.
Document Type
Academic Journal
Author
van Grootel RWJ; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.; van den Bosch AE; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.; Baggen VJM; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.; Menting ME; Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.; Baart SJ; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands.; Cuypers JAAE; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.; Witsenburg M; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.; Roos-Hesselink JW; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: j.roos@erasmusmc.nl.
Source
Publisher: Mosby-Year Book Country of Publication: United States NLM ID: 8801388 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6795 (Electronic) Linking ISSN: 08947317 NLM ISO Abbreviation: J Am Soc Echocardiogr Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Adult patients with repaired tetralogy of Fallot (ToF) are at risk for complications such as heart failure and sudden cardiac death, and identifying high-risk patients is important. Reduced left ventricular (LV) and right ventricular (RV) function has been identified as a predictor of outcomes. However, LV ejection fraction is often preserved, and RV function is difficult to assess. With the introduction of strain analysis, an easy and more sensitive parameter became available. The aim of this study was to investigate the association between strain variables and cardiovascular events in patients with ToF.
Methods: Stable adult patients with repaired ToF were consecutively included in a prospective observational study between 2011 and 2013 (N = 151; median age, 33.2 years [interquartile range, 25.5-42.0 years]; 61.6% men). For the left ventricle, global longitudinal strain and apical and basal rotation were measured, and longitudinal strain was measured for the right ventricle. The primary endpoint was a composite of death or heart failure. The secondary endpoint was a composite of death, heart failure, arrhythmia, reintervention, or hospitalization for cardiac reasons.
Results: During a median follow-up period of 71.5 months (interquartile range, 64.0-75.3 months), the primary and secondary endpoints occurred in 14 (9%) and 62 (41%) patients, respectively. After adjusting for LV ejection fraction and LV global longitudinal strain, RV longitudinal strain remained independently associated with the primary endpoint in a ridge regression analysis. LV apical rotation remained independently associated with the secondary end point (adjusted hazard ratio, 0.72; 95% CI, 0.52-0.98; P = .035) after adjusting for age, New York Heart Association functional class, QRS duration, LV ejection fraction, RV longitudinal strain, and LV global longitudinal strain.
Conclusions: Myocardial deformation variables of both the left and right ventricles were associated with cardiovascular events in patients with ToF. LV and RV longitudinal strain and LV rotation should become part of the routine assessment of patients with ToF.
(Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
Methods: Stable adult patients with repaired ToF were consecutively included in a prospective observational study between 2011 and 2013 (N = 151; median age, 33.2 years [interquartile range, 25.5-42.0 years]; 61.6% men). For the left ventricle, global longitudinal strain and apical and basal rotation were measured, and longitudinal strain was measured for the right ventricle. The primary endpoint was a composite of death or heart failure. The secondary endpoint was a composite of death, heart failure, arrhythmia, reintervention, or hospitalization for cardiac reasons.
Results: During a median follow-up period of 71.5 months (interquartile range, 64.0-75.3 months), the primary and secondary endpoints occurred in 14 (9%) and 62 (41%) patients, respectively. After adjusting for LV ejection fraction and LV global longitudinal strain, RV longitudinal strain remained independently associated with the primary endpoint in a ridge regression analysis. LV apical rotation remained independently associated with the secondary end point (adjusted hazard ratio, 0.72; 95% CI, 0.52-0.98; P = .035) after adjusting for age, New York Heart Association functional class, QRS duration, LV ejection fraction, RV longitudinal strain, and LV global longitudinal strain.
Conclusions: Myocardial deformation variables of both the left and right ventricles were associated with cardiovascular events in patients with ToF. LV and RV longitudinal strain and LV rotation should become part of the routine assessment of patients with ToF.
(Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)