Key result
In adults with repaired tetralogy of Fallot, a cardiac index <2.4 L/min/m2 was associated with a 74.3% cumulative probability of adverse cardiac events at 10 years vs 22.4% for CI ≥2.4 (P<0.0001).
Why the study?
Multiple cardiac parameters correlate with poor outcomes in repaired tetralogy of Fallot with significant residual pulmonary regurgitation, but the utility of cardiac index had never been studied.
Does a low cardiac index predict adverse cardiac events in adults with repaired tetralogy of Fallot and significant pulmonary regurgitation?
Cohort (n=55)
No
Does a low cardiac index predict adverse cardiac events in adults with repaired tetralogy of Fallot and significant pulmonary regurgitation?
May support cardiac index for risk stratification in repaired tetralogy of Fallot; hypothesis-generating and requires prospective validation.
Many cardiac parameters have been associated with poor outcomes in patients with repaired tetralogy of Fallot (TOF) and significant residual pulmonary regurgitation (PR). However, the utility of cardiac index (CI) in these patients has never been studied. Our study aimed to assess if a low CI is associated with the development of adverse cardiac events in this population and compare it to other established cardiac parameters. All patients with repaired TOF and significant PR who had a cardiac magnetic resonance imaging (CMR) at our institution were enrolled. CI was measured by CMR and their charts were reviewed for the development of the following outcomes: worsening NYHA class, admission for heart failure, arrhythmias, and sudden cardiac death. Fifty-five patients were included in the study. Median age was 28 years and mean follow-up was 9.5 years. Eighteen patients (32.7%) developed one or more of the predefined outcomes. Their CI was significantly lower compared to patients without adverse events (CI 2.3 vs. 2.8 L/min/m2; p-value = 0.0045). CI alone had a better yield in predicting adverse events when compared to the other combined CMR parameters (AUC 0.78 vs 0.61). Patients with a CI < 2.4 had a 74.3% cumulative probability of developing adverse cardiac events at 10 years compared to 22.4% in patients with a CI ≥ 2.4 (p-value<0.0001). In adults with repaired TOF and significant residual PR, CI appears to be the best predictor of midterm adverse cardiac events. Whether it can be used for timing of pulmonary valve replacement remains to be studied.
No takes yet. Share an insight, caveat, or question.
Fadous et al. (2021) conducted a cohort in Repaired tetralogy of Fallot with significant residual pulmonary regurgitation (n=55). Cardiac index < 2.4 L/min/m2 vs. Cardiac index ≥ 2.4 L/min/m2 was evaluated on Adverse cardiac events (worsening NYHA class, admission for heart failure, arrhythmias, and sudden cardiac death) (p=<0.0001). In adults with repaired tetralogy of Fallot, a cardiac index <2.4 L/min/m2 was associated with a 74.3% cumulative probability of adverse cardiac events at 10 years vs 22.4% for CI ≥2.4 (P<0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: