Rapid Fire Abstracts
Jose Luis Reyes, MD
Consultant
Hospital Vall d'Hebron, Spain
FILIPA VALENTE, MD
Cardiologist. Advanced cardiac imaging
Hospital Universitari Vall d'Hebron, Spain
Blanca Gordon, MD
Consultant
Hospital Vall d'Hebron, Spain
Victor Gonzalez, MD
Consultant
Hospital Vall d'Hebron, Spain
Ruper Oliveró, MSc, BSc
Cardiologist
Vall d'Hebron Hospital, Spain
Guillem Casas Masnou, MD
Cardiologist
Hospital Universitari Vall d'Hebron, Spain
Gisela Teixido Tura, MD, PhD
Doctor
Hospital Vall d'Hebron, Spain
Jose Luis Reyes, MD
Consultant
Hospital Vall d'Hebron, Spain
HUG CUELLAR CALABRIA, MD, PhD
Radiologist. Cardiac imaging
Hospital Universitari Vall d'Hebron, Spain
Laura Dos, MD, PhD
Consultant
Hospital Vall d'Hebron, Spain
José F Rodríguez Palomares, MD, PhD, FSCMR
Head of Cardiovascular Imaging Department
Hospital Vall d'Hebron, Spain
Severe pulmonary regurgitation remains one of the main long-term complications after early repair of Tetralogy of Fallot (rTOF). Although definite factors determining optimal timing for pulmonary valve replacement (PVR) are still lacking, both left (LV) and right ventricular (RV) systolic dysfunction have been shown to be predictive of outcome. The aim of our study was to analyze biventricular myocardial deformation parameters before and after PVR and to assess their predictive value for adverse events.
Methods:
Between 2008 and 2022, 90 patients with rTOF underwent a basal CMR study before a first-time PVR and a repeat CMR during follow-up. Strain parameters of both ventricles were analyzed with CMR feature tracking. Healthy controls (n=25) were also analyzed for comparison of strain values. The primary outcome was a composite of death, heart failure, arrhythmia or ICD implantation.
Results:
Deformation parameters were significantly worse in rTOF patients compared with healthy controls for both the right and left ventricle, as were LV ejection fraction (EF) and RVEF (Table 1), although mean LVEF was in the normal range. After PVR, there was a significant decrease in RVEF but an improvement of LVEF and of all analyzed strain values (Table 1). During a median follow-up of 82 ± 46 months, 13 patients reached the composite endpoint with 2 deaths, 1 heart failure hospitalization, 1 arrhythmic event managed with ablation and 9 ICD implantations. Occurrence of an adverse event was significantly associated with lower LVEF, larger end-systolic RV volume and worse RV global circumferential and radial strain (Table 2 and linear regression analysis with p = 0.04, 0.02, 0.03 and 0.05, respectively). RV global circumferential strain showed the highest sensitivity for prediction of adverse outcome with 70% sensitivity and an AUC of 0.683 on ROC curve analysis for a cut-off of -11.7%.
Conclusion:
In patients with rTOF and severe pulmonary regurgitation, strain parameters are significantly reduced for both the RV and LV and improve after PVR. RV GCS was the best predictor of adverse events with a cut-off value of -11.7%.
