Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?

Background: Many cardiac parameters have been associated with poor outcomes in patients with repaired tetralogy of Fallot (TOF) and significant residual pulmonary regurgitation (PR). However, the utility of cardiac index (CI) in these patients has never been studied. Our study aimed to assess if a l...

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Autores principales:	Maria Fadous, Maria-Victoria Ordoñez, Carlos-Eduardo Guerrero-Chalela, Aihua Liu, Liming Guo, Luc Jutras, Ariane J. Marelli, Judith Therrien
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Cardiac index Cardiac magnetic resonance imaging Adult congenital heart disease Tetralogy of Fallot Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/f1d83ec3388b4b91ad2023e2233a5fc5
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spelling	oai:doaj.org-article:f1d83ec3388b4b91ad2023e2233a5fc52021-11-06T04:38:06ZCardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?2666-668510.1016/j.ijcchd.2021.100222https://doaj.org/article/f1d83ec3388b4b91ad2023e2233a5fc52021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666668521001464https://doaj.org/toc/2666-6685Background: Many cardiac parameters have been associated with poor outcomes in patients with repaired tetralogy of Fallot (TOF) and significant residual pulmonary regurgitation (PR). However, the utility of cardiac index (CI) in these patients has never been studied. Our study aimed to assess if a low CI is associated with the development of adverse cardiac events in this population and compare it to other established cardiac parameters. Methods: All patients with repaired TOF and significant PR who had a cardiac magnetic resonance imaging (CMR) at our institution were enrolled. CI was measured by CMR and their charts were reviewed for the development of the following outcomes: worsening NYHA class, admission for heart failure, arrhythmias, and sudden cardiac death. Results: Fifty-five patients were included in the study. Median age was 28 years and mean follow-up was 9.5 years. Eighteen patients (32.7%) developed one or more of the predefined outcomes. Their CI was significantly lower compared to patients without adverse events (CI 2.3 vs. 2.8 L/min/m2; p-value = 0.0045). CI alone had a better yield in predicting adverse events when compared to the other combined CMR parameters (AUC 0.78 vs 0.61). Patients with a CI < 2.4 had a 74.3% cumulative probability of developing adverse cardiac events at 10 years compared to 22.4% in patients with a CI ≥ 2.4 (p-value<0.0001). Conclusion: In adults with repaired TOF and significant residual PR, CI appears to be the best predictor of midterm adverse cardiac events. Whether it can be used for timing of pulmonary valve replacement remains to be studied.Maria FadousMaria-Victoria OrdoñezCarlos-Eduardo Guerrero-ChalelaAihua LiuLiming GuoLuc JutrasAriane J. MarelliJudith TherrienElsevierarticleCardiac indexCardiac magnetic resonance imagingAdult congenital heart diseaseTetralogy of FallotDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology Congenital Heart Disease, Vol 5, Iss , Pp 100222- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cardiac index Cardiac magnetic resonance imaging Adult congenital heart disease Tetralogy of Fallot Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Cardiac index Cardiac magnetic resonance imaging Adult congenital heart disease Tetralogy of Fallot Diseases of the circulatory (Cardiovascular) system RC666-701 Maria Fadous Maria-Victoria Ordoñez Carlos-Eduardo Guerrero-Chalela Aihua Liu Liming Guo Luc Jutras Ariane J. Marelli Judith Therrien Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?
description	Background: Many cardiac parameters have been associated with poor outcomes in patients with repaired tetralogy of Fallot (TOF) and significant residual pulmonary regurgitation (PR). However, the utility of cardiac index (CI) in these patients has never been studied. Our study aimed to assess if a low CI is associated with the development of adverse cardiac events in this population and compare it to other established cardiac parameters. Methods: All patients with repaired TOF and significant PR who had a cardiac magnetic resonance imaging (CMR) at our institution were enrolled. CI was measured by CMR and their charts were reviewed for the development of the following outcomes: worsening NYHA class, admission for heart failure, arrhythmias, and sudden cardiac death. Results: Fifty-five patients were included in the study. Median age was 28 years and mean follow-up was 9.5 years. Eighteen patients (32.7%) developed one or more of the predefined outcomes. Their CI was significantly lower compared to patients without adverse events (CI 2.3 vs. 2.8 L/min/m2; p-value = 0.0045). CI alone had a better yield in predicting adverse events when compared to the other combined CMR parameters (AUC 0.78 vs 0.61). Patients with a CI < 2.4 had a 74.3% cumulative probability of developing adverse cardiac events at 10 years compared to 22.4% in patients with a CI ≥ 2.4 (p-value<0.0001). Conclusion: In adults with repaired TOF and significant residual PR, CI appears to be the best predictor of midterm adverse cardiac events. Whether it can be used for timing of pulmonary valve replacement remains to be studied.
format	article
author	Maria Fadous Maria-Victoria Ordoñez Carlos-Eduardo Guerrero-Chalela Aihua Liu Liming Guo Luc Jutras Ariane J. Marelli Judith Therrien
author_facet	Maria Fadous Maria-Victoria Ordoñez Carlos-Eduardo Guerrero-Chalela Aihua Liu Liming Guo Luc Jutras Ariane J. Marelli Judith Therrien
author_sort	Maria Fadous
title	Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?
title_short	Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?
title_full	Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?
title_fullStr	Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?
title_full_unstemmed	Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?
title_sort	cardiac index in adults with repaired tetralogy of fallot: are we missing the forest for the trees?
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/f1d83ec3388b4b91ad2023e2233a5fc5
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Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?

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