Why the study?
Patients with hypoplastic left ventricles undergoing recruitment or biventricular repair risk adverse outcomes, but whether pre-repair LV shape predicts outcome remains unknown.
Do baseline or post-recruitment left ventricular shape parameters derived from statistical shape modeling predict the decision to proceed with biventricular repair or major adverse cardiovascular events in children with hypoplastic left ventricles?
Do baseline or post-recruitment left ventricular shape parameters derived from statistical shape modeling predict the decision to proceed with biventricular repair or major adverse cardiovascular events in children with hypoplastic left ventricles?
Although hypoplastic left ventricles gain size and sphericity during staged recruitment, baseline and post-recruitment LV shape characteristics do not predict outcomes after biventricular repair, whereas higher baseline RV mass index and endocardial fibroelastosis are independent predictors of major adverse cardiovascular events.
BACKGROUND: Patients with hypoplastic left ventricles (LV) who undergo volume-loading procedures (recruitment, biventricular [BIV] repair) are at risk for adverse outcomes, including heart failure and death. We investigated pre-BIV LV shape as a predictor of outcome after BIV repair in patients with hypoplastic LVs. METHODS: ). Statistical shape modeling (SSM) was utilized to generate a model of the shape and variability of LVs. Traditional measures of LV sphericity and eccentricity were also measured. Major adverse cardiovascular events (MACE) included heart failure, transplant, and death. A wide variation in LV shape was found by SSM, and shape modes were associated with right ventricle (RV) and LV size, and diagnosis. BIV repair was achieved in 74/95 (78%) patients; 13/74 (18%) of BIV patients had MACE. Predictors of MACE following BIV repair included EFE, higher RV mass index, and higher RV end-diastolic volume index. No baseline or post-recruitment LV shape parameter was associated with the outcome after BIV repair. CONCLUSION: The shape model of hypoplastic LVs demonstrated a wide array of LV shapes. LVs gained sphericity and size and lost eccentricity with recruitment. Though the ventricles changed shape with recruitment, no specific LV shape characteristic at the baseline or post-recruitment stage was predictive of decision to proceed with BIV repair or outcome. Higher RV mass and volume may represent new biomarkers that predict outcomes following BIV repair in patients with hypoplastic LV. Further investigation could determine the reproducibility of these findings.
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Barnet et al. (2024) studied this question.
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