Cardiac magnetic resonance parameters to predict ventricular arrhythmias inducibility before pulmonary valve replacement in patient with tetralogy of Fallot - 07/09/23

Doi : 10.1016/j.acvdsp.2023.07.006

Grégoire Albenque, MD ^1,^⁎, Francis Bessière, PhD, MD ², Gilles Soulat, PhD, MD ^3,⁴, Arshid Azarine, MD ⁵, Mohamed Bakloul, MD ⁶, Emre Belli, MD ¹, Damien Bonnet, PhD, MD ^3,⁷, Loic Boussel, PhD, MD ², Eric Bruguière, MD ⁸, Sarah Cohen, PhD, MD ^1,⁹, Hubert Delasnerie, MD ⁸, Sylvie Di Filippo, MD ², Arnaud Dulac, MD ², Kevin Gardey, MD ², Roland Henaine, MD ², Laurence Iserin, MD ⁶, Clément Karsenty, PhD, MD ⁸, Magalie Ladouceur, PhD, MD ^3,⁶, Antoine Legendre, MD ^6,⁷, Sophie Malekzadeh-Milani, MD ⁸, Alice Maltret, MD ¹, Eloi Marijon, PhD, MD ^3,¹⁰, Elie Mousseaux, PhD, MD ³, Jelena Radojevic, MD ¹, Miarisoa Ratsimandresy, MD ⁸, Sébastien Hascoët, PhD, MD ^1,⁹, Nicolas Combes, MD ^1,⁸, Victor Waldmann, PhD, MD ^3,^4,^7,¹⁰
¹ Department of Congenital Heart Diseases, Centre de référence malformations cardiaques congénitales complexes M3C, hôpital Marie-Lannelongue, groupe hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France
² Louis Pradel Hospital, hospices civils de Lyon, université Lyon 1 Claude-Bernard, Lyon, France
³ Université Paris Cité, Inserm, PARCC, 75015 Paris, France
⁴ Department of Radiology, Georges-Pompidou European Hospital, AP–HP, 75015 Paris, France
⁵ Radiology Department, groupe hospitalier Paris Saint-Joseph, Paris, France
⁶ Adult Congenital Heart Disease Medico-Surgical Unit, European Georges-Pompidou Hospital, Paris, France
⁷ M3C-Necker, hôpital universitaire Necker-Enfants-malades, AP–HP, Paris, France
⁸ Pasteur Clinic, Toulouse, France
⁹ Université Paris-Saclay, UVSQ, Inserm, CESP U1018, Le Kremlin-Bicêtre, France
¹⁰ Cardiac Electrophysiology Unit, European Georges-Pompidou Hospital, Paris, France

^⁎Corresponding author.

Résumé

Introduction

Ventricular arrhythmias and sudden death are recognized complications of tetralogy of Fallot (TOF). Electrophysiological study (EPS) is increasingly performed prior to pulmonary valve replacement (PVR) in these patients to evaluate and treat the arrhythmic substrate.

Objective

We aimed to assess the value of cardiac magnetic resonance (CMR) to refine pre-operative risk stratification in this population.

Methods

A prospective multicenter study was conducted to systematically assess EPS in patients with TOF referred for PVR from January 2020 to December 2021. Multiple CMR parameters were analyzed and correlated with EPS results.

Results/Expected results

Among a total of 120 patients enrolled, 108 (90.0%) patients who had a CMR prior to EPS were analyzed. A VA was inducible in 24 (22.2%) patients. Clinical characteristics of patients associated with EPS results are presented in Table 1. Concerning CMR variables, mean RV end-diastolic volume index was 157±39ml and was not statistically different in patients with positive vs. negative EPS (164±49 vs. 155±35, P=0.395). However, a RV/LV end-diastolic volume index ratio>2.4 was significantly associated with a higher likelihood of inducibility (OR 3.10, 95%CI 1.14–8.74, P=0.040). Mean RV end-systolic volume index tended to be upper in patient with positive EPS (101±35 vs. 86±26, P=0.072). The RV ejection fraction measured on CMR also tended to be slightly lower in patients with positive EPS (40±7 vs. 43±9, P=0.069) unlike the LV ejection fraction (P=0.600). Mean pulmonary annulus diameter were also significantly associated with positive EPS (31±8 vs. 26±7mm, OR 1.10 [1.02–1.18] per 1mm increment, P=0.012). A pulmonary annulus diameter>28mm was associated with an OR of 2.9 [1.10–8.11] (P=0.047). In multivariable analysis, RV/LV end-diastolic volume index ratio>2.4 (OR 4.6 [1.2–22.5], P=0.036) and history of atrial arrhythmia (OR 10.9 [2.6–60.8], P=0.002) remained independent predictors of VA inducibility (Fig. 1).

Conclusion/Perspectives

In patients with TOF prior to PVR, RV/LV end-diastolic volume index ratio and pulmonary annulus diameter are associated with ventricular arrhythmia inducibility during EPS. CMR parameters, in combination with other clinical factors, may be useful to improve pre-operative risk stratification.

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Vol 15 - N° 4

P. 275 - septembre 2023 Retour au numéro

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Cardiac magnetic resonance parameters to predict ventricular arrhythmias inducibility before pulmonary valve replacement in patient with tetralogy of Fallot - 07/09/23

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