title: Late gadolinium enhancement and adverse outcomes in a contemporary cohort of adult survivors of tetralogy of Fallot.
abstract: OBJECTIVE
  Myocardial fibrosis has been associated with poorer outcomes in tetralogy of Fallot, however only a handful of studies have assessed its significance in the current era. Our aim was to quantify the amount of late gadolinium enhancement in both the LV and RV in a contemporary cohort of adults with surgically repaired tetralogy of Fallot, and assess the relationship with adverse clinical outcomes.
  
  
  METHODS
  Single centre cohort study SETTING: National tertiary referral center Patients: One hundred fourteen patients with surgically repaired tetralogy of Fallot with median age 29.5 years (range 17.5-64.2). Prospective follow-up for mean 2.4 years (SD 1.29).
  
  
  METHODS
  Cardiovascular magnetic resonance was performed, and late gadolinium enhancement mass was estimated for the LV using the 5-SD remote myocardium method, and for the RV using a segmental scoring system. Cohort characterization was determined through the use of a computerized database.
  
  
  METHODS
  Survival analysis from time of scan to first adverse event, defined as an episode of atrial arrhythmia, sustained ventricular arrhythmia, hospitalization with heart failure, or implantable cardioverter-defibrillator insertion.
  
  
  RESULTS
  Eleven patients experienced an adverse outcome in the follow-up period, although there were no deaths. LV late gadolinium enhancement was associated with adverse outcomes in a univariate model (P = .027). However, when adjusted for age at scan the significant variables included NYHA class (P = .006), peak oxygen uptake (P = .028), number of prior sternotomies (P = .044), and higher indexed RV and LV end diastolic volumes (P = .002 and P < .001), but not RV or LV late gadolinium enhancement.
  
  
  CONCLUSIONS
  Formal quantification of late gadolinium enhancement is not currently as helpful in ascertaining prognosis compared to other, more easily assessed parameters in a contemporary cohort of tetralogy of Fallot survivors, however assessment particularly of the LV holds promise for the future.
authors.affiliation: Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Clydebank, Dunbartonshire, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Dobson
authors.affiliation: British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Ify
authors.initials: I
authors.lastname: Mordi
authors.affiliation: Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Clydebank, Dunbartonshire, United Kingdom.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Danton
authors.affiliation: Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Clydebank, Dunbartonshire, United Kingdom.
authors.forename: Niki L
authors.initials: NL
authors.lastname: Walker
authors.affiliation: Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Clydebank, Dunbartonshire, United Kingdom.
authors.forename: Hamish A
authors.initials: HA
authors.lastname: Walker
authors.affiliation: British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tzemos
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003287:Contrast Media; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012606:Scotland; D017741:Survivors; D062606:Tertiary Care Centers; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine
keywords: arrhythmia; cardiac MRI; tetralogy of Fallot