Key result
A resting QRS duration >160 ms after tetralogy of Fallot repair strongly correlated with right ventricular enlargement and predicted a failure to normalize right ventricular volume after pulmonary valve replacement.
Why the study?
To normalize RV volume after PVR for repaired TOF, PVR should occur before RVEDVI reaches 170 ml/m2, prompting evaluation of QRS duration, CTR, and BNP as markers for optimal timing.
Is QRS duration a useful marker for predicting right ventricular volume normalization after pulmonary valve replacement in patients with repaired tetralogy of Fallot?
Observational (n=26)
No
Is QRS duration a useful marker for predicting right ventricular volume normalization after pulmonary valve replacement in patients with repaired tetralogy of Fallot?
Effect estimate: r=0.69
p-value: p=<0.001
A QRS duration of 160 ms serves as a sensitive clinical cutoff for predicting right ventricular volume normalization after pulmonary valve replacement in patients with repaired tetralogy of Fallot.
QRS duration may flag RV enlargement prompting cMRI in repaired TOF; leaves open its role guiding optimal PVR timing.
In pulmonary valve replacement (PVR) after tetralogy of Fallot (TOF) repair, it is recommended that PVR be performed before the right ventricular end-diastolic volume index (RVEDVI) reaches 170 ml/m2 on cardiac magnetic resonance imaging (cMRI) to normalize the RV volume after PVR. We examined the utility of QRS duration, cardiothoracic ratio (CTR), and plasma brain natriuretic peptide (BNP) as markers of an enlarged RV volume to perform PVR at the optimal timing. We assessed the correlation of QRS duration, CTR, and BNP with RVEDVI and RVESVI on cMRI in 26 patients after TOF repair. Fifteen patients underwent PVR (age, 45.2 ± 11.4 years). The RV volume changes from before to after PVR were investigated. Twelve patients underwent post-PVR cMRI. QRS duration, BNP, and CTR were positively correlated with RVEDVI and RVESVI after TOF repair. The post-PVR QRS duration was also positively correlated with post-PVR RVEDVI (p = 0.017) and RVESVI (p = 0.001). From before to after PVR, in cases with QRS duration ≤ 160 ms, the QRS duration decreased from 110.4 ± 28.9 to 101.8 ± 30.5 ms (p = 0.063). Both RVEDVI and RVESVI decreased to the normal range in 4 of 5 cases. In contrast, in cases with QRS duration > 160 ms, the QRS duration decreased from 183.0 ± 17.4 to 160.3 ± 23.8 ms (p = 0.013); however, RVESVI did not normalize in 6 of 7 cases. A prolonged QRS duration is a useful marker of RVEDVI and RVESVI enlargement after TOF repair. A QRS duration of 160 ms is a sensitive cutoff value for predicting RV volume normalization after PVR.
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Sugiura et al. (2022) conducted an observational in Tetralogy of Fallot with pulmonary regurgitation (n=26). QRS duration > 160 ms vs. QRS duration ≤ 160 ms was evaluated on Correlation between QRS duration and right ventricular end-systolic volume index (RVESVI) after TOF repair (r=0.69, p=<0.001). A resting QRS duration >160 ms after tetralogy of Fallot repair strongly correlated with right ventricular enlargement and predicted a failure to normalize right ventricular volume after pulmonary valve replacement.
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