Differences in right ventricular-pulmonary vascular coupling and clinical indices between repaired standard tetralogy of Fallot and repaired tetralogy of Fallot with pulmonary atresia - 06/06/20

Doi : 10.1016/j.diii.2020.05.008

S. Buddhe ^a, V. Jani ^b, S. Sarikouch ^c, L. Gaur ^b, A. Schuster ^d, P. Beerbaum ^e, M. Lewin ^a, S. Kutty ^b,⁎
^a Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, 91805 Seattle, WA, USA
^b Blalock Taussig Thomas Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans St, 21287 Baltimore, MD, USA
^c Department of Heart- Thoracic- Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
^d Department of Cardiology and Pneumology, University of Goettingen School of Medicine, 37075 Göttingen, Germany
^e Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover Medical School, Hannover, Germany

^⁎Corresponding author at: Blalock Taussig Thomas Heart Center, The Johns Hopkins Hospital and School of Medicine, 1800 Orleans St, 21287 Baltimore, MD, USA.USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 06 June 2020
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Highlights

•	There is a relationship between ventricular vascular coupling ratio and traditional cardiovascular magnetic resonance imaging parameters.
•	Ventricular vascular coupling ratio is greater in patients with repaired tetralogy of Fallot and pulmonary compared to those with repaired standard tetralogy of Fallot.
•	Ventricular vascular coupling ratio is of potential clinical value as an indicator of right heart performance in tetralogy of Fallot.

Le texte complet de cet article est disponible en PDF.

Abstract

Purpose

The purpose of this study was to compare ventricular vascular coupling ratio (VVCR) between patients with repaired standard tetralogy of Fallot (TOF) and those with repaired TOF-pulmonary atresia (TOF-PA) using cardiovascular magnetic resonance (CMR).

Materials and methods

Patients with repaired TOF aged>6 years were prospectively enrolled for same day CMR, echocardiography, and exercise stress test following a standardized protocol. Sanz's method was used to calculate VVCR as right ventricle (RV) end-systolic volume/pulmonary artery stroke volume. Regression analysis was used to examine associations with exercise test parameters, New York Heart Association (NYHA) class, RV size and biventricular systolic function.

Results

A total of 248 subjects were included; of these 222 had repaired TOF (group I, 129 males; mean age, 15.9±4.7 [SD] years [range: 8–29 years]) and 26 had repaired TOF-PA (group II, 14 males; mean age, 17.0±6.3 [SD] years [range: 8–29 years]). Mean VVCR for all subjects was 1.54±0.64 [SD] (range: 0.43–3.80). Mean VVCR was significantly greater in the TOF-PA group (1.81±0.75 [SD]; range: 0.78–3.20) than in the standard TOF group (1.51±0.72 [SD]; range: 0.43–3.80) (P=0.03). VVCR was greater in the 68 NYHA class II subjects (1.79±0.66 [SD]; range: 0.75–3.26) compared to the 179 NYHA class I subjects (1.46±0.61 [SD]; range: 0.43–3.80) (P<0.001).

Conclusion

Non-invasive determination of VVCR using CMR is feasible in children and adolescents. VVCR showed association with NYHA class, and was worse in subjects with repaired TOF-PA compared to those with repaired standard TOF. VVCR shows promise as an indicator of pulmonary artery compliance and cardiovascular performance in this cohort.

Le texte complet de cet article est disponible en PDF.

Keywords : Tetralogy of Fallot, Magnetic resonance imaging, Pulmonary atresia, Pulmonary artery, Right ventricular dysfunction

Abbreviations : CMR, CPET, Ea, EDVi, Ees, EF, ESVi, IQR, LV, MAPCA, NYHA, PA, PI, QRS, rTOF, RV, SV, TOF, VVCR