title: Left ventricular longitudinal function predicts life-threatening ventricular arrhythmia and death in adults with repaired tetralogy of fallot.
abstract: BACKGROUND
  Sudden cardiac death and life-threatening ventricular arrhythmia remain a concern in adult patients with repaired tetralogy of Fallot. Longitudinal left ventricular (LV) function is sensitive in detecting early myocardial damage and may have prognostic implications in this setting.
  
  
  RESULTS
  We included 413 tetralogy of Fallot patients (age, 36 ± 13 years; QRS duration, 148 ± 27 milliseconds; LV ejection fraction, 55 ± 10%). A composite end point of sudden cardiac death/life-threatening ventricular arrhythmia (sustained ventricular tachycardia, resuscitated sudden cardiac death, or appropriate implantable cardioverter-defibrillator discharge) was used. During a median follow-up of 2.9 years, 5 patients died suddenly, 9 had documented sustained ventricular tachycardia, and another 5 had appropriate implantable cardioverter-defibrillator shocks. On univariate Cox analysis, QRS duration (hazard ratio [HR], 1.02 per 1 ms; P=0.046), right atrial area (HR, 1.05 per 1 cm(2); P=0.02), right ventricular fractional area change (HR, 0.94 per 1%; P=0.02), right ventricular outflow tract diameter (HR, 1.08 per 1 mm; P=0.01), mitral annular plane systolic excursion (HR, 0.84 per 1 mm; P=0.03), and LV global longitudinal 2-dimensional strain (HR, 0.87 per 1%; P=0.03) were related to the combined end point. On bivariable analysis, mitral annular plane systolic excursion and LV global longitudinal 2-dimensional strain were related to outcome independently of QRS duration (P=0.002 and P=0.01, respectively). In addition, a combination of echocardiographic variables, including right atrial area, right ventricular fractional area change, and LV global longitudinal 2-dimensional strain or mitral annular plane systolic excursion, was also found to be significantly related to outcome (P<0.001; c statistic, 0.70).
  
  
  CONCLUSIONS
  LV longitudinal dysfunction was associated with greater risk of sudden cardiac death/life-threatening ventricular arrhythmias. In combination with echocardiographic right heart variables, also available from routine echocardiography, these measures provide important outcome information and should be considered a useful adjunct to established markers such as QRS duration in the estimation of prognosis in this challenging population.
authors.affiliation: Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany. gerhard.diller@gmail.com
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kempny
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Liodakis
authors.forename: Rafael
authors.initials: R
authors.lastname: Alonso-Gonzalez
authors.forename: Ryo
authors.initials: R
authors.lastname: Inuzuka
authors.forename: Anselm
authors.initials: A
authors.lastname: Uebing
authors.forename: Stefan
authors.initials: S
authors.lastname: Orwat
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.forename: Helmut
authors.initials: H
authors.lastname: Baumgartner
mesh_terms: D000328:Adult; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000401:mortality*; D013771:Tetralogy of Fallot / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult