A weighted risk score integrating late gadolinium enhancement extent and clinical factors strongly predicted all-cause mortality (HR 1.07 per 1-point increase) in adults with repaired tetralogy of Fallot.
Cohort (n=550)
No
Does a risk score integrating LGE CMR and clinical markers predict mortality and ventricular arrhythmias in patients with repaired tetralogy of Fallot?
A novel risk score integrating LGE CMR and clinical markers accurately identifies adults with repaired Tetralogy of Fallot at high risk for mortality and malignant ventricular arrhythmias.
Estimación del efecto: HR 1.07 (95% CI 1.05-1.08)
valor p: p=<0.001
This study sought to identify patients with repaired tetralogy of Fallot (rTOF) at high risk of death and malignant ventricular arrhythmia (VA). To date there is no robust risk stratification scheme to predict outcomes in adults with rTOF. Consecutive patients were prospectively recruited for late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) to define right and left ventricular (RV, LV) fibrosis in addition to proven risk markers. The primary endpoint was all-cause mortality. Of the 550 patients (median age 32 years, 56% male), 27 died (mean follow-up 6.4 ± 5.8; total 3,512 years). Mortality was independently predicted by RVLGE extent, presence of LVLGE, RV ejection fraction ≤47%, LV ejection fraction ≤55%, B-type natriuretic peptide ≥127 ng/L, peak exercise oxygen uptake (V02) ≤17 mL/kg/min, prior sustained atrial arrhythmia, and age ≥50 years. The weighted scores for each of the preceding independent predictors differentiated a high-risk subgroup of patients with a 4.4%, annual risk of mortality (area under the curve AUC: 0.87; P < 0.001). The secondary endpoint (VA), a composite of life-threatening sustained ventricular tachycardia/resuscitated ventricular fibrillation/sudden cardiac death occurred in 29. Weighted scores that included several predictors of mortality and RV outflow tract akinetic length ≥55 mm and RV systolic pressure ≥47 mm Hg identified high-risk patients with a 3.7% annual risk of VA (AUC: 0.79; P < 0.001) RVLGE was heavily weighted in both risk scores caused by its strong relative prognostic value. We present a score integrating multiple appropriately weighted risk factors to identify the subgroup of patients with rTOF who are at high annual risk of death who may benefit from targeted therapy.
Ghonim et al. (Thu,) conducted a cohort in Repaired Tetralogy of Fallot (n=550). Weighted-risk score incorporating LGE CMR and clinical factors was evaluated on All-cause mortality (HR 1.07, 95% CI 1.05-1.08, p=<0.001). A weighted risk score integrating late gadolinium enhancement extent and clinical factors strongly predicted all-cause mortality (HR 1.07 per 1-point increase) in adults with repaired tetralogy of Fallot.