PMID- 34875276 OWN - NLM STAT- MEDLINE DCOM- 20220407 LR - 20240214 IS - 1097-6744 (Electronic) IS - 0002-8703 (Linking) VI - 245 DP - 2022 Mar TI - Cardiac MRI predictors of good long-term outcomes in patients with repaired TOF. PG - 70-77 LID - S0002-8703(21)00468-3 [pii] LID - 10.1016/j.ahj.2021.11.015 [doi] AB - BACKGROUND: Risk stratification in patients with repaired tetralogy of Fallot (rTOF) have focused on poor clinical outcomes while predictors of a benign clinical course have not been characterized. OBJECTIVE: The goal of this study was to Identify cardiac magnetic resonance (CMR) markers of a good clinical course late after TOF repair. METHODS: Clinical and CMR data from the International Multicenter TOF Registry (INDICATOR) were analyzed. The primary outcome was time to the earliest occurrence of a composite of death, aborted sudden death, and sustained ventricular tachycardia (VT). The secondary outcome was time to the earliest occurrence of atrial arrhythmia, nonsustained VT, and NYHA class >II. Multinomial regression was used to identify predictors of the 3-category outcome: (a) good outcome, defined as freedom from the primary AND secondary outcomes at age 50 years; (b) poor outcome, defined as presence of the primary outcome before age 50 years; and (c) intermediate outcome, defined as not fulfilling criteria for good or poor outcomes. RESULTS: Among 1088 eligible patients, 96 had good outcome, 60 experienced poor outcome, and 932 had intermediate outcome. Patients were age 25.8+/-10.8 years at the time of the index CMR. Median follow-up was 5.8 years (IQR 3.0, 9.9) after CMR in event-free patients. By univariate analysis, smaller right ventricular (RV) end-systolic and end-diastolic volume index, smaller left ventricular end-systolic volume index, higher right and left ventricular ejection fraction, lower right and left ventricular mass index, and lower left ventricular mass/volume ratio were associated with good outcome. Multivariable modeling identified higher RV ejection fraction (OR 2.38 per 10% increase, P = .002) and lower RV mass index (OR 1.72, per 10 g/m(2) decrease, P = .002) as independently associated with good outcome after adjusting for age at CMR. Classification and regression tree analysis identified important thresholds associated with good outcome that were specific to patients age >/=37 years at the time of CMR; these were RV ejection fraction >/=42% and RV mass index <39 g/m(2). CONCLUSIONS: Adults with rTOF and no more than mild RV dysfunction combined with no significant RV hypertrophy are likely to be free from serious adverse clinical events into their sixth decade of life and may require less frequent cardiac testing. CI - Copyright (c) 2021 Elsevier Inc. All rights reserved. FAU - Majeed, Amara AU - Majeed A AD - Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA. Electronic address: amara.majeedcardio@chboston.org. FAU - Geva, Tal AU - Geva T AD - Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA. FAU - Sleeper, Lynn A AU - Sleeper LA AD - Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA. FAU - Graf, Julia A AU - Graf JA AD - Department of Cardiology, Boston Children's Hospital, Boston, MA. FAU - Lu, Minmin AU - Lu M AD - Department of Cardiology, Boston Children's Hospital, Boston, MA. FAU - Babu-Narayan, Sonya V AU - Babu-Narayan SV AD - Department of Adult Congenital Heart Disease, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; and National Heart Lung Institute, Imperial College London, United Kingdom. FAU - Wald, Rachel M AU - Wald RM AD - University of Toronto, Toronto, ON, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto ON, Canada. FAU - Mulder, Barbara J M AU - Mulder BJM AD - Department of Cardiology, Academic Medical Center, Amsterdam, NH, The Netherlands; Academic Medical Center, Amsterdam, NH, The Netherlands. FAU - Valente, Anne Marie AU - Valente AM AD - Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA. LA - eng GR - FS/11/38/28864/BHF_/British Heart Foundation/United Kingdom GR - R01 HL089269/HL/NHLBI NIH HHS/United States GR - DH_/Department of Health/United Kingdom PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20211204 PL - United States TA - Am Heart J JT - American heart journal JID - 0370465 SB - IM MH - Adolescent MH - Adult MH - Humans MH - Magnetic Resonance Imaging MH - Middle Aged MH - Retrospective Studies MH - Stroke Volume MH - *Tetralogy of Fallot MH - *Ventricular Dysfunction, Right MH - Ventricular Function, Left MH - Ventricular Function, Right MH - Young Adult EDAT- 2021/12/08 06:00 MHDA- 2022/04/08 06:00 CRDT- 2021/12/07 20:12 PHST- 2021/06/21 00:00 [received] PHST- 2021/10/20 00:00 [revised] PHST- 2021/11/18 00:00 [accepted] PHST- 2021/12/08 06:00 [pubmed] PHST- 2022/04/08 06:00 [medline] PHST- 2021/12/07 20:12 [entrez] AID - S0002-8703(21)00468-3 [pii] AID - 10.1016/j.ahj.2021.11.015 [doi] PST - ppublish SO - Am Heart J. 2022 Mar;245:70-77. doi: 10.1016/j.ahj.2021.11.015. Epub 2021 Dec 4.