PMID- 16432072
OWN - NLM
STAT- MEDLINE
DCOM- 20060227
LR  - 20220316
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 113
IP  - 3
DP  - 2006 Jan 24
TI  - Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults 
      with repaired tetralogy of fallot and its relationship to adverse markers of 
      clinical outcome.
PG  - 405-13
AB  - BACKGROUND: Late morbidity and mortality remain problematic after repair of 
      tetralogy of Fallot (TOF). We hypothesized that fibrosis detected by late 
      gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) would be 
      present in adults with repaired TOF and would be related to adverse markers of 
      outcome. METHOD AND RESULTS: LGE was scored in the right and left ventricles (RV 
      and LV) of 92 adult patients who had undergone TOF repair. RV LGE was seen in all 
      patients at surgical sites located in the outflow tract (99%) or the site of 
      ventricular septal defect patching (98%) and in the inferior RV insertion point 
      (79%) and trabeculated myocardium (24%). LV LGE (53%) was located at the apex 
      consistent with apical vent insertion (49%), in the inferior or lateral wall 
      consistent with infarction (5%), or in other areas (8%). Patients with 
      supramedian RV LGE score were older (38 versus 27 years, P<0.001) and more 
      symptomatic (38% versus 8% in New York Heart Association class II or greater, 
      P=0.001), had increased levels of atrial natriuretic peptide (7.3 versus 4.9 
      pmol/L, P=0.041), and had a trend to higher brain natriuretic peptide (12.3 
      versus 7.2 pmol/L, P=0.086), exercise intolerance (maximum VO2 24 versus 28 
      mL.min(-1).kg(-1), P=0.021), RV dysfunction (RV end-systolic volume 61 versus 55 
      mL/m2, P=0.018; RV ejection fraction 50% versus 56%, P=0.007), and clinical 
      arrhythmia (26% versus 10%, P=0.039). Non-apical vent LV LGE also correlated with 
      markers of adverse outcome. In a multivariate model, RV LGE remained a predictor 
      of arrhythmia. CONCLUSIONS: RV and LV LGE were common after TOF repair and were 
      related to adverse clinical markers, including ventricular dysfunction, exercise 
      intolerance, and neurohormonal activation. Furthermore, RV LGE was significantly 
      associated with clinical arrhythmia.
FAU - Babu-Narayan, Sonya V
AU  - Babu-Narayan SV
AD  - Adult Congenital Heart Unit, Royal Brompton Hospital, London SW3 6NP, United 
      Kingdom. sonya@doctors.org.uk
FAU - Kilner, Philip J
AU  - Kilner PJ
FAU - Li, Wei
AU  - Li W
FAU - Moon, James C
AU  - Moon JC
FAU - Goktekin, Omer
AU  - Goktekin O
FAU - Davlouros, Periklis A
AU  - Davlouros PA
FAU - Khan, Mohammed
AU  - Khan M
FAU - Ho, Siew Yen
AU  - Ho SY
FAU - Pennell, Dudley J
AU  - Pennell DJ
FAU - Gatzoulis, Michael A
AU  - Gatzoulis MA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Arrhythmias, Cardiac/pathology
MH  - Child
MH  - Child, Preschool
MH  - Fibrosis
MH  - Gadolinium
MH  - Heart Diseases/*epidemiology/*pathology/surgery
MH  - Humans
MH  - Magnetic Resonance Imaging/*methods/standards
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Reproducibility of Results
MH  - Risk Factors
MH  - Tetralogy of Fallot/*epidemiology/*surgery
MH  - Treatment Outcome
MH  - Ventricular Dysfunction/pathology
EDAT- 2006/01/25 09:00
MHDA- 2006/02/28 09:00
CRDT- 2006/01/25 09:00
PHST- 2006/01/25 09:00 [pubmed]
PHST- 2006/02/28 09:00 [medline]
PHST- 2006/01/25 09:00 [entrez]
AID - 113/3/405 [pii]
AID - 10.1161/CIRCULATIONAHA.105.548727 [doi]
PST - ppublish
SO  - Circulation. 2006 Jan 24;113(3):405-13. doi: 10.1161/CIRCULATIONAHA.105.548727.