Key result
Higher pre-PVR systolic surface area-to-volume ratio was independently associated with optimal right ventricular remodeling after pulmonary valve replacement (OR 1.68 per 0.1 cm2/mL increase).
Why the study?
Optimal RV reverse remodeling after PVR in repaired tetralogy of Fallot is not fully predicted by volume-based pre-PVR parameters.
Does higher pre-PVR right ventricular surface area-to-volume ratio (SAVR) predict optimal ventricular remodeling after pulmonary valve replacement in patients with repaired tetralogy of Fallot?
Observational (n=80)
Open-label
No
Does higher pre-PVR right ventricular surface area-to-volume ratio (SAVR) predict optimal ventricular remodeling after pulmonary valve replacement in patients with repaired tetralogy of Fallot?
Odds Ratio: 1.68 (95% CI 1.003–2.83)
p-value: p=0.049
In patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, a higher pre-operative right ventricular systolic surface area-to-volume ratio (SAVR) independently predicts optimal post-operative reverse remodeling.
Background Optimal reverse remodeling of the right ventricle (RV), a sentinel goal of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot, is not fully predicted by volume-based pre-PVR parameters. Our objectives were to characterize novel geometric RV parameters in patients receiving PVR and in controls, and to identify associations between these parameters and chamber remodeling post-PVR. Methods Secondary analysis was performed on cardiac magnetic resonance (CMR) data from 60 patients enrolled in a randomized trial of PVR with and without surgical RV remodeling. 20 healthy age-matched subjects served as controls. The primary outcome was optimal post-PVR RV remodeling (end-diastolic volume index (EDVi) ≤ 114 ml/m 2 and ejection fraction (EF) ≥ 48%) vs. suboptimal remodeling (EDVi ≥ 120 ml/m 2 and EF ≤ 45%). Results RV geometry was markedly different in PVR patients compared with controls, with lower systolic surface area-to-volume ratio (SAVR) (1.16 ± 0.26 vs.1.44 ± 0.21 cm 2 /mL, p < 0.001) and lower systolic circumferential curvature (0.87 ± 0.27 vs. 1.07 ± 0.30 cm − 1 , p = 0.007) but similar longitudinal curvature. In the PVR cohort, higher systolic SAVR was associated with higher RVEF both pre- and post-PVR (p < 0.001). Among PVR patients, 15 had optimal and 19 had suboptimal remodeling post-PVR. Multivariable modeling showed that among the geometric parameters, higher systolic SAVR (OR 1.68 per 0.1 cm 2 /mL increase; p = 0.049) and shorter systolic RV long-axis length (OR 0.92 per 0.1 cm increase; p = 0.035) were independently associated with optimal remodeling. Conclusions Compared with controls, PVR patients have lower SAVR and lower circumferential but not longitudinal curvature. Higher pre-PVR systolic SAVR is associated with optimal remodeling post-PVR.
No takes yet. Share an insight, caveat, or question.
Thatte et al. (2023) conducted an observational in Repaired tetralogy of Fallot with chronic pulmonary regurgitation (n=80). Pre-PVR systolic surface area-to-volume ratio (SAVR) vs. Lower SAVR was evaluated on Optimal post-PVR RV remodeling (EDVi ≤ 114 ml/m2 and EF ≥ 48%) vs. suboptimal remodeling (EDVi ≥ 120 ml/m2 and EF ≤ 45%) (OR 1.68, 95% CI 1.003, 2.83, p=0.049). Higher pre-PVR systolic surface area-to-volume ratio was independently associated with optimal right ventricular remodeling after pulmonary valve replacement (OR 1.68 per 0.1 cm2/mL increase).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: