title: Myocardial deformation parameters predict outcome in patients with repaired tetralogy of Fallot.
abstract: BACKGROUND
  Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function and to predict outcome in repaired tetralogy of Fallot (ToF). We aimed to test the hypothesis that parameters of myocardial deformation on cardiac MRI (CMR) relate to symptoms and provide prognostic information in patients with repaired ToF.
  
  
  RESULTS
  We included 372 patients with ToF (median age 16 years; 55% male), recruited within a nationwide, prospective study. Longitudinal (LS), circumferential (CS) and radial global strain (RS) were analysed by CMR-based feature tracking (FT). A combined endpoint of death, successful resuscitation or documented ventricular tachycardia was employed. Parameters of global strain were associated with New York Heart Association (NYHA) class and symptomatic deterioration. During a median follow-up of 7.4 years, 20 events occurred. Left ventricular (LV) CS and right ventricular (RV) LS emerged as predictors of outcome, independent of QRS duration, LV/RV ejection fraction and volumes, NYHA class and peak oxygen uptake. In combination, these parameters also identified a subgroup of patients at significantly increased risk of adverse of outcomes (HR 3.3, p=0.002). Furthermore, LV LS, RS, CS and RV LS were related to the risk of death and nearly missed death (p<0.05 for all).
  
  
  CONCLUSIONS
  FT-CMR provides myocardial deformation parameters, easily derived from standard CMR studies. They relate to symptoms and clinical deterioration in patients with ToF. More importantly, they predict adverse outcome independent of established risk markers, and should be considered as a useful adjunct to established outcome predictors, especially in younger patients with ToF.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov: NCT00266188; Results.
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Orwat
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kempny
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Radke
authors.affiliation: Institute for Biometry and Medical Informatics, University of Magdeburg, Magdeburg, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Peters
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany.
authors.forename: Titus
authors.initials: T
authors.lastname: Kühne
authors.affiliation: Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Boethig
authors.affiliation: Department of Diagnostic and Interventional Radiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.affiliation: Department of Paediatric Cardiology, Heartcenter of North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany.
authors.forename: Karl-Otto
authors.initials: KO
authors.lastname: Dubowy
authors.affiliation: Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Hannover, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Beerbaum
authors.affiliation: Department of Heart-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Germany.
authors.forename: Samir
authors.initials: S
authors.lastname: Sarikouch
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Baumgartner
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D005260:Female; D006321:Heart / Q000503:physiopathology; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D013771:Tetralogy of Fallot / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*; D055815:Young Adult