title: Optimal follow-up in adult patients with congenital heart disease and chronic pulmonary regurgitation: towards tailored use of cardiac magnetic resonance imaging.
abstract: BACKGROUND
  Pulmonary regurgitation (PR) is a common complication of right ventricular outflow tract (RVOT) reconstruction and leads to right ventricular (RV) dilatation and dysfunction. Although cardiac magnetic resonance (CMR) is the gold standard for evaluating PR and RV dysfunction, cost and limited availability are problems in many centres.
  
  
  OBJECTIVE
  To determine clinical, electrocardiographic and echocardiographic predictors of these complications and optimize patient selection for their short-term follow-up by CMR.
  
  
  METHODS
  Ninety-four patients with a history of RVOT repair were prospectively included. All patients had a clinical examination, electrocardiography, echocardiography and CMR.
  
  
  RESULTS
  QRS duration, indexed end-diastolic RV (EDRV) diameter and area on echocardiography were significantly associated with RV dilatation on CMR (P<0.001). The distal localization of Doppler PR flow was the strongest echocardiographic criterion associated with severe PR (P<0.001). Arrhythmia history and high Tei index were significantly associated with low RV ejection fraction (P<0.001 and P=0.017, respectively). In multivariable analysis, grade of PR, QRS duration, arrhythmia and valvulotomy were strongly associated with severe PR and RV dilatation or systolic RV dysfunction. From these results, an approach based on a scaled scoring system for selecting patients who need short-term CMR evaluation and close follow-up was evaluated. This method should avoid 31% of CMR examinations, with a sensitivity of 97.7%.
  
  
  CONCLUSIONS
  Clinical, electrocardiographic and echocardiographic criteria can be used to accurately evaluate patients with RVOT repair. The combination of such features facilitates identification of patients who do or do not require close CMR evaluation.
authors: Department of Paediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C, Necker Hospital, Université Paris Descartes, France. magalie.ladouceur@egp.aphp.fr
authors: Magalie
authors: M
authors: Ladouceur
authors: Florence
authors: F
authors: Gillaizeau
authors: Alban
authors: A
authors: Redheuil
authors: Laurence
authors: L
authors: Iserin
authors: Damien
authors: D
authors: Bonnet
authors: Younes
authors: Y
authors: Boudjemline
authors: Elie
authors: E
authors: Mousseaux
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003661:Decision Support Techniques; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult