Key result
A 5%-point decrease in left ventricular ejection fraction was an independent predictor of mortality (HR 1.16; 95% CI 1.16-1.24; P=0.003) in adults after tetralogy of Fallot repair.
Why the study?
Despite significant cardiovascular mortality after tetralogy of Fallot repair, data on the risk and prognostic implications of left ventricular cardiomyopathy were limited.
Does left ventricular systolic dysfunction increase the risk of cardiovascular events in adult patients after tetralogy of Fallot repair?
Cohort (n=574)
Does left ventricular systolic dysfunction increase the risk of cardiovascular events in adult patients after tetralogy of Fallot repair?
Left ventricular systolic dysfunction is present in a significant minority of adults after TOF repair and is independently associated with increased cardiovascular mortality and events.
Answers are grounded in this paper and cite their sources.
May warrant closer LVEF monitoring in adult TOF survivors; leaves open whether LV-targeted therapy alters mortality.
Background Despite the significant risk of cardiovascular mortality after tetralogy of Fallot (TOF) repair, there are limited data about left ventricular (LV) cardiomyopathy in this population, thus creating important knowledge gaps. This study aims to address some of these knowledge gaps by describing the risk and prognostic implications of LV systolic dysfunction (LVD) after TOF repair. Methods We performed a cohort study of adult patients after TOF repair with an echocardiographic assessment of LV ejection fraction (LVEF) to determine the association between LVD and cardiovascular events, defined as sustained ventricular tachycardia, aborted sudden death, heart transplantation, or death. Prevalent and incidence LVD were defined as LVEF < 50% at baseline or new decrease in LVEF to < 50% during follow-up, respectively. Results Of 574 patients (age 38 ± 13 years), the baseline LVEF was 57% ± 9% and 68 (12%) had prevalent LVD. Cardiovascular events occurred in 126 patients (22%) during 10.5 ± 6.2 years of follow-up. LVEF was an independent predictor of mortality (hazard ratio, 1.16; 95% confidence interval, 1.16-1.24; P = 0.003) per 5%-point decrease in LVEF. Among the 357 patients with preserved LVEF and echocardiographic follow-up, incident LVD occurred in 23 (6%) during 3.8 ± 1.6 years of follow-up. Event-free survival was significantly lower in patients with incident LVD compared with patients without incident LVD (87% vs 71%, P = 0.021). Conclusion Prevalent and incident LVD occurred in 12% and 6% of this cohort, respectively, and were associated with lower event-free survival. Incident LVD suggests the presence of subclinical LV cardiomyopathy, and further studies are required to determine optimal strategies for diagnosing and treating subclinical LV cardiomyopathy to improve outcomes in the population with TOF.
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Egbe et al. (2019) conducted a cohort in Tetralogy of Fallot (TOF) repair (n=574). Left ventricular systolic dysfunction (LVD) / LVEF decrease vs. Preserved LVEF was evaluated on Mortality (HR 1.16, 95% CI 1.16-1.24, p=0.003). A 5%-point decrease in left ventricular ejection fraction was an independent predictor of mortality (HR 1.16; 95% CI 1.16-1.24; P=0.003) in adults after tetralogy of Fallot repair.
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