Key result
Pathological biventricular remodeling patterns, characterized by left ventricular basal dilation and reduced right ventricular apical ejection fraction, were associated with adverse events.
Why the study?
Maladaptive remodelling mechanisms in repaired tetralogy of Fallot lead to metabolic and structural changes, but whether biventricular shape analysis identifies novel remodelling patterns linked to adverse events independent of pulmonary regurgitant volume index remains unknown.
Cohort (n=192)
Yes
Biventricular shape analysis using CMR identifies maladaptive remodeling patterns, such as LV basal dilation and reduced RV apical ejection fraction, that predict adverse events in repaired tetralogy of Fallot independently of pulmonary regurgitation.
Answers are grounded in this paper and cite their sources.
CMR biventricular shape analysis may refine risk stratification in repaired tetralogy of Fallot; hypothesis-generating and requires prospective validation.
BACKGROUND: Maladaptive remodelling mechanisms occur in patients with repaired tetralogy of Fallot (rToF) resulting in a cycle of metabolic and structural changes. Biventricular shape analysis may indicate mechanisms associated with adverse events independent of pulmonary regurgitant volume index (PRVI). We aimed to determine novel remodelling patterns associated with adverse events in patients with rToF using shape and function analysis. METHODS: Biventricular shape and function were studied in 192 patients with rToF (median time from TOF repair to baseline evaluation 13.5 years). Linear discriminant analysis (LDA) and principal component analysis (PCA) were used to identify shape differences between patients with and without adverse events. Adverse events included death, arrhythmias, and cardiac arrest with median follow-up of 10 years. RESULTS: LDA and PCA showed that shape characteristics pertaining to adverse events included a more circular left ventricle (LV) (decreased eccentricity), dilated (increased sphericity) LV base, increased right ventricular (RV) apical sphericity, and decreased RV basal sphericity. Multivariate LDA showed that the optimal discriminative model included only RV apical ejection fraction and one PCA mode associated with a more circular and dilated LV base (AUC = 0.77). PRVI did not add value, and shape changes associated with increased PRVI were not predictive of adverse outcomes. CONCLUSION: Pathological remodelling patterns in patients with rToF are significantly associated with adverse events, independent of PRVI. Mechanisms related to incident events include LV basal dilation with a reduced RV apical ejection fraction.
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Lamata et al. (2022) conducted a cohort in Repaired tetralogy of Fallot (n=192). Pathological biventricular remodeling patterns (high LDA score) vs. Absence of pathological remodeling (low LDA score) was evaluated on Composite of death, life-threatening arrhythmias, and cardiac arrest (OR 2.06, 95% CI 1.08-3.93). Pathological biventricular remodeling patterns, characterized by left ventricular basal dilation and reduced right ventricular apical ejection fraction, were associated with adverse events.
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