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Impact of Right Ventricular Pressure Load After Repair of Tetralogy of Fallot

2022; Wiley; Volume: 11; Issue: 7 Linguagem: Inglês

10.1161/jaha.121.022694

2047-9980

Heiner Latus, Jana Stammermann, Inga Voges, Birgit Waschulzik, Matthias Gutberlet, Gerhard‐Paul Diller, Dietmar Schranz, Peter Ewert, Philipp Beerbaum, Titus Kühne, Samir Sarikouch, Gunter Kerst, Majed Kanaan, Corinna Lebherz, André Rüffer, Dimitrios Gkalpakiotis, Andrea Schedifka, G. Buheitel, Joachim Streble, Rainer Willing, S. Schubert, Kai Thorsten Laser, Eugen Sandica, Burkhard Trusen, Felix Berger, Oliver Miera, Stanislav Ovroutski, Katharina Schmitt, Joachim Photiadis, Felix Berger, Bernd Opgen‐Rhein, Katja Weiss, Sabine Klaassen, Christoph Berns, Thomas P. Van Boeckel, Guido Haverkämper, Andreas Kästner, Heike Koch, Björn Peters, Florian Schmidt, Jens Timme, Konstanze Engel, Birgit Franzbach, Gabriela Senft, Frank Beyer, Klaus Winter, Judith Breuer, Martin Schneider, J. Bahlmann, Eberhard Griese, Trong Phi Lê, Joachim Hebe, Jan‐Hendrik Nürnberg, Annette Magsaam, Ronald Müller, Ludger Potthoff, R Voigt, Timothy Krüger, Hubert Gerleve, Ulrich Kleideiter, Dirk Schneider‐Kulla, J. Krülls-Münch, Thomas Menke, Martin Lehn, Antje Heilmann, Helge Tomczak, G. Tarusinov, Michael Scheid, Ertan Mayatepek, Frank Pillekamp, Artur Lichtenberg, Christiane Terpeluk, Bruno Kolterer, Sven Dittrich, Ulrike Gundlach, Robert Cesnjevar, Carsten Müntjes, G Morf, Anoosh Esmaeili, Stephan Backhoff, Brigitte Stiller, Friedhelm Beyersdorf, Johannes Kroll, Nicole Häffner, Jannos Siaplaouras, Antje Masri‐Zada, Christian Jux, Andreas Böning, Hakan Akintürk, Thomas Paul, Matthias Sigler, Theodor Tirilomis, G Schürer, Johannes Hartmann, Ralph Grabitz, Uta Liebaug, Claudius Rotzsch, Rainer Kozlik‐Feldmann, Carsten Rickers, Thomas S. Mir, M. Hübler, Jörg S. Sachweh, Stefan Renz, Andreas Schemm, Bernd Friedrich, Otmar Schlobohm, Dietmar Böthig, Burkhard Wermter, Andrea Kelter‐Klöpping, Alexander Horke, Johann Bauersachs, Mechthild Westhoff‐Bleck, Matthias Gorenflo, Matthias Karck, Tsvetomir Loukanov, Hermann Schrüfer, Martin Wilken, Hashim Abdul‐Khaliq, Tanja Rädle‐Hurst, Axel Rentzsch, Hans‐Joachim Schäfers, Hagen Reichert, Daniel Vilser, Thomas Kriebel, Arnulf Boysen, Anselm Uebing, Inga Voges, Tim Attmann, J Cremer, Jens Scheewe, Regina Buchholz‐Berdau, Peter C. Möller, Thorsten Horter, Konrad Brockmeier, Gerardus B. W. E Bennink, Stephan Baldus, A. Gillor, Tim Niehues, Wolfgang Lawrenz, Steffen Leidig, Ingo Dähnert, Frank‐Thomas Riede, Martin Kostelka, Liane Kändler, Martin Bethge, Stefan Köster, Christoph Schröder, Jens Karstedt, Uwe Seitz, Christoph Kampmann, Daniel‐Sebastian Dohle, Frank Stahl, Mojtaba Abedini, Joachim Müller‐Scholden, Peter Ewert, Alfred Hager, Michael Huntgeburth, Harald Kaemmerer, Nicole Nagdyman, Jörg Schoetzau, Oktay Tutarel, Rüdiger Lange, Jürgen Hörer, Nikolaus A. Haas, Jürgen Hörer, Michael Winn Hauser, Alexander Roithmaier, Hans‐Gerd Kehl, Astrid E. Lammers, Edward Malec, Helmut Baumgartner, Gerhard‐Paul Diller, Roswitha Bahle, G. Hofner, Stefan Zink, R Reif, H. Singer, Christoph Parlasca, Matthias W. Freund, Michaël Schumacher, Oliver Dewald, Christine Darrelmann, Olaf Willmann, Norbert Schmiedl, Peter Quick, Dirk Hillebrand, Stephan Michele Eiselt, Torsten Nekarda, Michael Eberhard, Georg Baier, Frank Uhlemann, Ioannis Tzanavaros, Alexander Beyer, Gudrun Binz, Steffen Hess, Thomas Teufel, Ronald‐Peter Handke, Michael Hofbeck, Renate Kaulitz, Ludger Sieverding, Christian Schlensak, Christian Apitz, Michael Kaestner, Jürgen Holtvogt, Carl‐Friedrich Wippermann, Sönke Hinz, Andreas Heusch, Johannes Wirbelauer, Wolfgang Brosi,

Coronary Artery Anomalies

Background Right ventricular outflow tract (RVOT) stenosis after repair of tetralogy of Fallot has been linked with favorable right ventricular remodeling but adverse outcomes. The aim of our study was to assess the hemodynamic impact and prognostic relevance of right ventricular pressure load in this population. Methods and Results A total of 296 patients with repaired tetralogy of Fallot (mean age, 17.8±7.9 years) were included in a prospective cardiovascular magnetic resonance multicenter study. Myocardial strain was quantified by feature tracking technique at study entry. Follow-up, including the need for pulmonary valve replacement, was assessed. The combined end point consisted of ventricular tachycardia and cardiac death. A higher echocardiographic RVOT peak gradient was significantly associated with smaller right ventricular volumes and less pulmonary regurgitation, but lower biventricular longitudinal strain. During a follow-up of 10.1 (0.1-12.9) years, the primary end point was reached in 19 of 296 patients (cardiac death, n=6; sustained ventricular tachycardia, n=2; and nonsustained ventricular tachycardia, n=11). A higher RVOT gradient was associated with the combined outcome (hazard ratio [HR], 1.03; 95% CI, 1.00-1.06; P=0.026), and a cutoff gradient of ≥25 mm Hg was predictive for cardiovascular events (HR, 3.69; 95% CI, 1.47-9.27; P=0.005). In patients with pulmonary regurgitation ≥25%, a mild residual RVOT gradient (15-30 mm Hg) was not associated with a lower risk for pulmonary valve replacement. Conclusions Higher RVOT gradients were associated with less pulmonary regurgitation and smaller right ventricular dimensions but were related to reduced biventricular strain and emerged as univariate predictors of adverse events. Mild residual pressure gradients did not protect from pulmonary valve replacement. These results may have implications for the indication for RVOT reintervention in this population.