Determinants of Left Ventricular Dysfunction and Remodeling in Patients With Corrected Tetralogy of Fallot

Autor: Jürgen Hedderich, Ravi V. Shah, Dominik Daniel Gabbert, Michael Jerosch-Herold, Ana C Andrade, Hans-Heiner Kramer, Carsten Rickers, Minh H Pham, Philip Wegner, Inga Voges
Rok vydání: 2019
Předmět:
Male
Time Factors
heart failure
030204 cardiovascular system & hematology
Ventricular Function
Left
030218 nuclear medicine & medical imaging
Ventricular Dysfunction
Left
0302 clinical medicine
Germany
Cardiopulmonary exercise test
Prevalence
Prospective Studies
tetralogy of Fallot
Child
Original Research
Tetralogy of Fallot
left ventricular remodeling
Exercise Tolerance
Ventricular Remodeling
medicine.diagnostic_test
Congenital Heart Disease
Treatment Outcome
Cardiorespiratory Fitness
Child
Preschool
Cardiology
Female
medicine.symptom
Cardiomyopathies
Cardiology and Cardiovascular Medicine
cardiopulmonary exercise test
Adult
Cardiac function curve
medicine.medical_specialty
Adolescent
cardiac magnetic resonance imaging
Magnetic Resonance Imaging
Cine
Asymptomatic
Young Adult
03 medical and health sciences
Oxygen Consumption
Cardiac magnetic resonance imaging
Internal medicine
medicine
Humans
In patient
business.industry
Infant
Recovery of Function
medicine.disease
Fibrosis
Cross-Sectional Studies
Case-Control Studies
Heart failure
Ventricular Function
Right
business
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.118.009618
Popis: Background The aim of this study was to identify in asymptomatic patients with repaired tetralogy of Fallot the prevalence and determinants of impaired left‐sided cardiac function and adverse ventricular remodeling and the relation of left ventricular (LV) dysfunction and remodeling with cardiopulmonary exercise capacity. Methods and Results In a cross‐sectional study, 103 patients with tetralogy of Fallot (median age, 16.3 years) in New York Heart Association class 1, with surgical repair at a median age of 1.1 years, and 63 age‐matched controls were studied. LV, right ventricular function and geometry, LV myocardial extracellular volume (n=57), and left atrial function were quantified with cardiac magnetic resonance. Peak oxygen consumption was measured by a standardized cardiopulmonary exercise test (n=70). Patients with tetralogy of Fallot had lower LV ejection fraction ( P =0.001; 49% below age‐adjusted fifth percentile for controls), lower LV mass index ( P =0.003), lower LV mass/volume ratio ( P P P =0.037). A peak oxygen consumption below the third percentile reference level was more likely with decreasing LV ejection fraction ( P =0.008), and lower LV mass index ( P =0.024), but independent of right ventricular ejection fraction. Conclusions In New York Heart Association class 1 patients with tetralogy of Fallot, frequent impaired systolic and diastolic LV function, LV adverse remodeling with LV atrophy, a decreased mass/volume ratio, and extracellular matrix expansion suggest cardiomyopathic changes. The best predictor for LV systolic dysfunction was the right ventricular mass/volume ratio. The subnormal peak oxygen consumption indicates that monitoring of LV status may be important for long‐term prognosis.
Databáze: OpenAIRE
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