PMID- 30514732 OWN - NLM STAT- MEDLINE DCOM- 20200507 LR - 20200507 IS - 1468-201X (Electronic) IS - 1355-6037 (Linking) VI - 105 IP - 11 DP - 2019 Jun TI - Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement. PG - 855-863 LID - 10.1136/heartjnl-2018-313961 [doi] AB - OBJECTIVE: The relationship between right ventricular (RV) fibrosis and right heart reverse remodelling following pulmonary valve replacement (PVR) has not been well studied in adults with repaired tetralogy of Fallot (rTOF). Our aims were to histologically quantify RV fibrosis and to explore the relationship between fibrosis severity and cardiac remodelling post-PVR. METHODS: Adults with rTOF and pre-PVR cardiovascular (CMR) imaging were consented to procurement of RV muscle during PVR. Samples were stained with picrosirius red to quantify collagen volume fraction. Clinical data at baseline and at last follow-up were reviewed. Adverse cardiovascular outcomes included death, sustained arrhythmia and heart failure. RESULTS: Fifty-three patients (male 58%, 38+/-11 years) were studied. Those with severe fibrosis (collagen volume fraction >11.0%, n=13) had longer aortic cross-clamp times at initial repair compared with the remainder of the population (50 vs 33 min, p=0.018) and increased RV mass:volume ratio pre-PVR (0.20 vs 0.18 g/mL, p=0.028). Post-PVR, the severe fibrosis group had increased indexed RV end-systolic volume index (RVESVi) (74 vs 66 mL/m(2), p=0.044), decreased RVESVi change (Delta29 vs Delta45 mL/m(2), p=0.005), increased RV mass (34 vs 25 g/m(2), p=0.023) and larger right atrial (RA) area (21 vs 17 cm(2), p=0.021). A trend towards increased heart failure events was observed in the severe fibrosis group (15% vs 0%, p=0.057). CONCLUSIONS: Severe RV fibrosis was associated with increased RVESVi, RV mass and RA area post-PVR in rTOF. Further study is required to define the impact of fibrosis and persistent right heart enlargement on clinical outcomes. CI - (c) Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Yamamura, Kenichiro AU - Yamamura K AD - Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada. FAU - Yuen, Darren AU - Yuen D AD - Division of Nephrology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. AD - Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada. FAU - Hickey, Edward J AU - Hickey EJ AD - Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada. AD - Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, SickKids Hospital, Toronto, Ontario, Canada. FAU - He, Xiaolin AU - He X AD - Division of Nephrology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. AD - Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada. FAU - Chaturvedi, Rajiv R AU - Chaturvedi RR AD - Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, University of Toronto, SickKids Hospital, Toronto, Ontario, Canada. FAU - Friedberg, Mark K AU - Friedberg MK AD - Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, University of Toronto, SickKids Hospital, Toronto, Ontario, Canada. FAU - Grosse-Wortmann, Lars AU - Grosse-Wortmann L AD - Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, University of Toronto, SickKids Hospital, Toronto, Ontario, Canada. AD - Department of Diagnostic Imaging, University of Toronto, SickKids Hospital, Toronto, Ontario, Canada. FAU - Hanneman, Kate AU - Hanneman K AD - Department of Medical Imaging, University of Toronto, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada. FAU - Billia, Filio AU - Billia F AD - Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada. FAU - Farkouh, Michael E AU - Farkouh ME AD - Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada. FAU - Wald, Rachel M AU - Wald RM AD - Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada. AD - Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada. AD - Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, University of Toronto, SickKids Hospital, Toronto, Ontario, Canada. AD - Department of Medical Imaging, University of Toronto, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20181204 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 SB - IM MH - Adult MH - Biopsy MH - Cardiomyopathies/*diagnosis/etiology/physiopathology MH - Female MH - Fibrosis/diagnosis/etiology/physiopathology MH - Follow-Up Studies MH - Heart Valve Prosthesis Implantation/*adverse effects MH - Heart Ventricles/diagnostic imaging/*physiopathology MH - Humans MH - Magnetic Resonance Imaging, Cine/methods MH - Male MH - Myocardium/*pathology MH - Pulmonary Valve/*surgery MH - Pulmonary Valve Insufficiency/diagnosis/physiopathology/*surgery MH - Retrospective Studies MH - Tetralogy of Fallot/surgery MH - Ventricular Function, Right/physiology MH - *Ventricular Remodeling OTO - NOTNLM OT - cardiac magnetic resonance (cmr) imaging OT - congenital heart disease surgery OT - tetralogy of fallot COIS- Competing interests: None declared. EDAT- 2018/12/06 06:00 MHDA- 2020/05/08 06:00 CRDT- 2018/12/06 06:00 PHST- 2018/08/01 00:00 [received] PHST- 2018/10/04 00:00 [revised] PHST- 2018/10/30 00:00 [accepted] PHST- 2018/12/06 06:00 [pubmed] PHST- 2020/05/08 06:00 [medline] PHST- 2018/12/06 06:00 [entrez] AID - heartjnl-2018-313961 [pii] AID - 10.1136/heartjnl-2018-313961 [doi] PST - ppublish SO - Heart. 2019 Jun;105(11):855-863. doi: 10.1136/heartjnl-2018-313961. Epub 2018 Dec 4.