Cardiac magnetic resonance parameters to predict ventricular arrhythmias inducibility before pulmonary valve replacement in patient with tetralogy of Fallot
MD Grégoire Albenque , PhD, MD Francis Bessière , PhD, MD Gilles Soulat , MD Arshid Azarine , MD Mohamed Bakloul , MD Emre Belli , PhD, MD Damien Bonnet , PhD, MD Loic Boussel , MD Eric Bruguière , PhD, MD Sarah Cohen , MD Hubert Delasnerie , MD Sylvie Di Filippo , MD Arnaud Dulac , MD Kevin Gardey , MD Roland Henaine , MD Laurence Iserin , PhD, MD Clément Karsenty , PhD, MD Magalie Ladouceur , MD Antoine Legendre , MD Sophie Malekzadeh-Milani , PhD, MD Victor Waldmann
{"title":"Cardiac magnetic resonance parameters to predict ventricular arrhythmias inducibility before pulmonary valve replacement in patient with tetralogy of Fallot","authors":"MD Grégoire Albenque , PhD, MD Francis Bessière , PhD, MD Gilles Soulat , MD Arshid Azarine , MD Mohamed Bakloul , MD Emre Belli , PhD, MD Damien Bonnet , PhD, MD Loic Boussel , MD Eric Bruguière , PhD, MD Sarah Cohen , MD Hubert Delasnerie , MD Sylvie Di Filippo , MD Arnaud Dulac , MD Kevin Gardey , MD Roland Henaine , MD Laurence Iserin , PhD, MD Clément Karsenty , PhD, MD Magalie Ladouceur , MD Antoine Legendre , MD Sophie Malekzadeh-Milani , PhD, MD Victor Waldmann","doi":"10.1016/j.acvdsp.2023.07.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span><span>Ventricular arrhythmias and sudden death are recognized complications of </span>tetralogy of Fallot (TOF). Electrophysiological study (EPS) is increasingly performed prior to </span>pulmonary valve replacement (PVR) in these patients to evaluate and treat the arrhythmic substrate.</p></div><div><h3>Objective</h3><p><span>We aimed to assess the value of cardiac magnetic resonance (CMR) to refine pre-operative </span>risk stratification in this population.</p></div><div><h3>Methods</h3><p>A prospective multicenter study was conducted to systematically assess EPS in patients with TOF referred for PVR from January 2020 to December 2021. Multiple CMR parameters were analyzed and correlated with EPS results.</p></div><div><h3>Results/Expected results</h3><p>Among a total of 120 patients enrolled, 108 (90.0%) patients who had a CMR prior to EPS were analyzed. A VA was inducible in 24 (22.2%) patients. Clinical characteristics of patients associated with EPS results are presented in Table 1. Concerning CMR variables, mean RV end-diastolic volume index was 157<!--> <!-->±<!--> <!-->39<!--> <!-->ml and was not statistically different in patients with positive vs. negative EPS (164<!--> <!-->±<!--> <!-->49 vs. 155<!--> <!-->±<!--> <!-->35, <em>P</em> <!-->=<!--> <!-->0.395). However, a RV/LV end-diastolic volume index ratio<!--> <!-->><!--> <!-->2.4 was significantly associated with a higher likelihood of inducibility (OR 3.10, 95%CI 1.14–8.74, <em>P</em> <!-->=<!--> <!-->0.040). Mean RV end-systolic volume index tended to be upper in patient with positive EPS (101<!--> <!-->±<!--> <!-->35 vs. 86<!--> <!-->±<!--> <!-->26, <em>P</em> <!-->=<!--> <span>0.072). The RV ejection fraction measured on CMR also tended to be slightly lower in patients with positive EPS (40</span> <!-->±<!--> <!-->7 vs. 43<!--> <!-->±<!--> <!-->9, <em>P</em> <!-->=<!--> <!-->0.069) unlike the LV ejection fraction (<em>P</em> <!-->=<!--> <!-->0.600). Mean pulmonary annulus diameter were also significantly associated with positive EPS (31<!--> <!-->±<!--> <!-->8 vs. 26<!--> <!-->±<!--> <!-->7<!--> <!-->mm, OR 1.10 [1.02–1.18] per 1<!--> <!-->mm increment, <em>P</em> <!-->=<!--> <!-->0.012). A pulmonary annulus diameter<!--> <!-->><!--> <!-->28<!--> <!-->mm was associated with an OR of 2.9 [1.10–8.11] (<em>P</em> <!-->=<!--> <!-->0.047). In multivariable analysis, RV/LV end-diastolic volume index ratio<!--> <!-->><!--> <!-->2.4 (OR 4.6 [1.2–22.5], <em>P</em> <!-->=<!--> <span>0.036) and history of atrial arrhythmia (OR 10.9 [2.6–60.8], </span><em>P</em> <!-->=<!--> <!-->0.002) remained independent predictors of VA inducibility (<span>Figure 1</span>).</p></div><div><h3>Conclusion/Perspectives</h3><p>In patients with TOF prior to PVR, RV/LV end-diastolic volume index ratio and pulmonary annulus diameter are associated with ventricular arrhythmia inducibility during EPS. CMR parameters, in combination with other clinical factors, may be useful to improve pre-operative risk stratification.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023002276","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Ventricular arrhythmias and sudden death are recognized complications of tetralogy of Fallot (TOF). Electrophysiological study (EPS) is increasingly performed prior to pulmonary valve replacement (PVR) in these patients to evaluate and treat the arrhythmic substrate.
Objective
We aimed to assess the value of cardiac magnetic resonance (CMR) to refine pre-operative risk stratification in this population.
Methods
A prospective multicenter study was conducted to systematically assess EPS in patients with TOF referred for PVR from January 2020 to December 2021. Multiple CMR parameters were analyzed and correlated with EPS results.
Results/Expected results
Among a total of 120 patients enrolled, 108 (90.0%) patients who had a CMR prior to EPS were analyzed. A VA was inducible in 24 (22.2%) patients. Clinical characteristics of patients associated with EPS results are presented in Table 1. Concerning CMR variables, mean RV end-diastolic volume index was 157 ± 39 ml and was not statistically different in patients with positive vs. negative EPS (164 ± 49 vs. 155 ± 35, P = 0.395). However, a RV/LV end-diastolic volume index ratio > 2.4 was significantly associated with a higher likelihood of inducibility (OR 3.10, 95%CI 1.14–8.74, P = 0.040). Mean RV end-systolic volume index tended to be upper in patient with positive EPS (101 ± 35 vs. 86 ± 26, P = 0.072). The RV ejection fraction measured on CMR also tended to be slightly lower in patients with positive EPS (40 ± 7 vs. 43 ± 9, P = 0.069) unlike the LV ejection fraction (P = 0.600). Mean pulmonary annulus diameter were also significantly associated with positive EPS (31 ± 8 vs. 26 ± 7 mm, OR 1.10 [1.02–1.18] per 1 mm increment, P = 0.012). A pulmonary annulus diameter > 28 mm was associated with an OR of 2.9 [1.10–8.11] (P = 0.047). In multivariable analysis, RV/LV end-diastolic volume index ratio > 2.4 (OR 4.6 [1.2–22.5], P = 0.036) and history of atrial arrhythmia (OR 10.9 [2.6–60.8], P = 0.002) remained independent predictors of VA inducibility (Figure 1).
Conclusion/Perspectives
In patients with TOF prior to PVR, RV/LV end-diastolic volume index ratio and pulmonary annulus diameter are associated with ventricular arrhythmia inducibility during EPS. CMR parameters, in combination with other clinical factors, may be useful to improve pre-operative risk stratification.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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