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J Am Coll Cardiol, 2004; 43:1068-1074, doi:10.1016/j.jacc.2003.10.045
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging

Tal Geva, MD, FACC*,*, Bryan M. Sandweiss, MD*, Kimberlee Gauvreau, ScD*, James E. Lock, MD, FACC* and Andrew J. Powell, MD, FACC*

* Department of Cardiology, Children's Hospital; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received June 17, 2003; revised manuscript received September 16, 2003, accepted October 6, 2003.

* Reprint requests and correspondence: Dr. Tal Geva, Department of Cardiology, Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, USA.
tal.geva{at}cardio.chboston.org

OBJECTIVES: The purpose of this study was to identify independent factors associated with impaired clinical status in late survivors of tetralogy of Fallot (TOF) repair.

BACKGROUND: Repair of TOF often results in chronic pulmonary regurgitation (PR) and right ventricular (RV) dilation, which have been linked to late morbidity and mortality. However, determinants of clinical status late after TOF repair have not been fully characterized.

METHODS: The clinical and laboratory data of 100 consecutive patients with repaired TOF (median 21 years after repair) who completed a cardiac magnetic resonance imaging protocol were analyzed. Impaired clinical status was defined as New York Heart Association (NYHA) functional class ≥III.

RESULTS: Of the patients, 88 were in NYHA functional class I or II and 12 were in NYHA functional class III. The degree of PR and indexed RV end-diastolic volume were not associated with impaired clinical status. By multivariate analysis, a lower left ventricular (LV) ejection fraction (EF) (odds ratio [OR] = 3.88 for 10% decrease, p = 0.002) and older age at TOF repair (OR = 1.70 for 5-year increase, p = 0.013) were the strongest independent factors associated with impaired clinical status. Among RV variables, a lower RV EF was the strongest independent factors associated with poor clinical status (OR = 2.41 for 10% decrease, p = 0.01). The LV EF correlated with RV EF (r = 0.58, p < 0.001).

CONCLUSIONS: Moderate or severe LV or RV systolic dysfunction, but not PR fraction or RV diastolic dimensions, is independently associated with impaired clinical status in long-term survivors of TOF repair. The close relationship between LV EF and RV EF suggests unfavorable ventricular-ventricular interaction.

Abbreviations and Acronyms
  ECG = electrocardiogram
  EF = ejection fraction
  LV = left ventricle/ventricular
  MRI = magnetic resonance imaging
  NYHA = New York Heart Association
  PA = pulmonary artery
  PR = pulmonary regurgitation
  ROC = receiver-operator characteristic
  RV = right ventricle/ventricular
  TOF = tetralogy of Fallot




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