PMID- 20394877
OWN - NLM
STAT- MEDLINE
DCOM- 20100615
LR  - 20211020
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 55
IP  - 16
DP  - 2010 Apr 20
TI  - Myocardial fibrosis identified by cardiac magnetic resonance late gadolinium 
      enhancement is associated with adverse ventricular mechanics and ventricular 
      tachycardia late after Fontan operation.
PG  - 1721-8
LID - 10.1016/j.jacc.2009.12.036 [doi]
AB  - OBJECTIVES: The purpose of this study was to evaluate the relationship between 
      myocardial fibrosis identified by cardiac magnetic resonance (CMR) and 
      ventricular performance and arrhythmias in patients late after the Fontan 
      operation. BACKGROUND: Patients who have undergone the Fontan palliation may 
      develop ventricular dysfunction and arrhythmias, but the mechanisms and risk 
      factors are poorly defined. METHODS: All patients who have had a Fontan operation 
      and a CMR study with the myocardial delayed-enhancement technique from January 
      2002 to November 2008 were retrospectively identified. RESULTS: Of 90 patients 
      (mean age at study was 23.1 +/- 10.9 years), 25 (28%) had positive late 
      gadolinium enhancement (LGE) in the ventricular myocardium. Patients with 
      positive LGE had lower mean ejection fraction (45% vs. 56%; p < 0.001), increased 
      median end-diastolic volume (100 ml/body surface area [BSA](1.3) vs. 82 
      ml/BSA(1.3); p = 0.004), increased median ventricular mass(i) (63 g/BSA(1.3) vs. 
      45 g/BSA(1.3); p < 0.001), higher frequency of regional wall motion abnormalities 
      (52% vs. 28%; p = 0.05), and higher frequency of nonsustained ventricular 
      tachycardia (NSVT) (36% vs. 11%; p = 0.01). Multivariate regression analysis 
      demonstrated that more extensive positive LGE, expressed as percent LGE of total 
      myocardial mass, was associated with lower ejection fraction (p = 0.002), 
      increased end-diastolic volume (p < 0.001), increased mass(i) (p < 0.001), and a 
      higher frequency of NSVT (odds ratio 1.2; 95% confidence interval: 1.1 to 1.4; p 
      = 0.006). CONCLUSIONS: In this cohort of late Fontan survivors, myocardial 
      fibrosis was common and associated with adverse ventricular mechanics and a 
      higher prevalence of NSVT. Further studies are warranted to examine the utility 
      of LGE for risk stratification and treatment of ventricular arrhythmia and 
      dysfunction in Fontan patients.
CI  - Copyright (c) 2010 American College of Cardiology Foundation. Published by 
      Elsevier Inc. All rights reserved.
FAU - Rathod, Rahul H
AU  - Rathod RH
AD  - Department of Cardiology, Children's Hospital Boston, Harvard Medical School, 
      Boston, Massachusetts 02115, USA.
FAU - Prakash, Ashwin
AU  - Prakash A
FAU - Powell, Andrew J
AU  - Powell AJ
FAU - Geva, Tal
AU  - Geva T
LA  - eng
GR  - T32 HL007572/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Contrast Media)
RN  - K2I13DR72L (Gadolinium DTPA)
SB  - IM
MH  - Contrast Media/administration & dosage
MH  - Electrocardiography
MH  - Endomyocardial Fibrosis/complications/*diagnosis/physiopathology
MH  - Female
MH  - Follow-Up Studies
MH  - Fontan Procedure/*adverse effects
MH  - *Gadolinium DTPA/administration & dosage
MH  - Heart Defects, Congenital/surgery
MH  - Heart Ventricles/pathology/physiopathology
MH  - Humans
MH  - Injections, Intravenous
MH  - Magnetic Resonance Imaging, Cine/*methods
MH  - Male
MH  - Myocardial Contraction/physiology
MH  - Myocardium/*pathology
MH  - Prognosis
MH  - Retrospective Studies
MH  - Stroke Volume/physiology
MH  - Tachycardia, Ventricular/diagnosis/*etiology/physiopathology
MH  - Time Factors
MH  - Ventricular Dysfunction/diagnosis/*etiology/physiopathology
MH  - Young Adult
PMC - PMC4266480
MID - NIHMS647132
EDAT- 2010/04/17 06:00
MHDA- 2010/06/16 06:00
PMCR- 2014/12/15
CRDT- 2010/04/17 06:00
PHST- 2009/09/22 00:00 [received]
PHST- 2009/11/23 00:00 [revised]
PHST- 2009/12/21 00:00 [accepted]
PHST- 2010/04/17 06:00 [entrez]
PHST- 2010/04/17 06:00 [pubmed]
PHST- 2010/06/16 06:00 [medline]
PHST- 2014/12/15 00:00 [pmc-release]
AID - S0735-1097(10)00597-8 [pii]
AID - 10.1016/j.jacc.2009.12.036 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2010 Apr 20;55(16):1721-8. doi: 10.1016/j.jacc.2009.12.036.