Left ventricular dysfunction in repaired tetralogy of Fallot: incidence and impact on atrial arrhythmias at long term-follow up.
Left ventricle (LV) systolic dysfunction in repaired tetralogy of Fallot (TOF) has been identified as a risk factor for functional status and adverse outcome. The aims of this cross-sectional followed by a prospective study were: (1) to evaluate the prevalence of LV systolic dysfunction in a large cohort of adults with repaired tetralogy of Fallot, (2) to test the relationship between LV systolic dysfunction and other known risk factors and (3) to evaluate the impact of LV systolic dysfunction on adverse cardiac events. In a multicenter study, 237 adults repaired TOF (58 % males, age 30 ± 10 years) were evaluated by cardiac magnetic resonance (CMR). Demographics, surgical history, ECG, Echo-Color Doppler and follow-up data were recorded. LV was dilated (Z value >2) in 16 patients (6 %), however 56 patients (23.6 %) had a reduced LV systolic function left ventricle ejection fraction (LVEF) (Z value <-2). Patients with LV systolic dysfunction were mainly males (82 %), had reduced right ventricle ejection fraction (RVEF), and higher right and left Late Gadolinium Enhanced scores. In a multivariate regression analysis male gender and RVEF resulted to be independent factors associated to LV systolic dysfunction. Atrial arrhythmias were the main adverse cardiac event at the follow-up and were associated to higher biventricular volumes and lower biventricular ejection fraction (EF); however multivariable analysis identified age, right ventricle end-diastolic volume (RVEDVi) and tricuspid regurgitation as independents factors associated to atrial arrhythmias. At long term follow-up at least ¼ of repaired TOF has LV dysfunction. Lower LVEF is associated to male gender and lower RVEF.
Institute of Clinical Physiology, The National Research Council (CNR), Via Aurelia Sud, 54100, Massa-Pisa, Italy. aitlamia@ifc.cnr.it.
Lamia
L
Ait Ali
Pediatric Cardiology Department, Giannina Gaslini Institute, Genova, Italy.
GianLuca
G
Trocchio
Pediatric Cardiology, Department of Cardiology, Regional Hospital S.Maurizio, Bolzano, Italy.
Roberto
R
Crepaz
Magnetic Resonance, Department of Radiology, Regional Hospital S.Maurizio, Bolzano, Italy.
Josef
J
Stuefer
Radiology Department, Giannina Gaslini Institute, Genova, Italy.
Nicola
N
Stagnaro
Institute of Clinical Physiology, The National Research Council (CNR), Via Aurelia Sud, 54100, Massa-Pisa, Italy.
Valeria
V
Siciliano
Institute of Clinical Physiology, The National Research Council (CNR), Via Aurelia Sud, 54100, Massa-Pisa, Italy.
Sabrina
S
Molinaro
Institute of Clinical Physiology, The National Research Council (CNR), Via Aurelia Sud, 54100, Massa-Pisa, Italy.
Rosa
R
Sicari
O.U. Pediatric Cardiology, Ospedale del cuore, Fondazione G. Monasterio-CNR, Regione Toscana, Italy.|MR Laboratory, Fondazione G. Monasterio-CNR, Regione Toscana, Italy.
Pierluigi
P
Festa
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016275:Atrial Function; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D017741:Survivors; D013599:Systole; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult
Cardiac magnetic resonance; Left ventricular dysfunction; Tetralogy of Fallot