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  • 1
    Online Resource
    Online Resource
    Impact of Right Ventricular Pressure Load After Repair of Tetralogy of Fallot
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American Heart Association Vol. 11, No. 7 ( 2022-04-05)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 7 ( 2022-04-05)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.121.022694
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2653953-6
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  • 2
    Online Resource
    Online Resource
    Sex-Specific Pediatric Percentiles for Ventricular Size and Mass as Reference Values for Cardiac MRI : Assessment by Steady-State Free-Precession and Phase-Contrast MRI Flow
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Circulation: Cardiovascular Imaging Vol. 3, No. 1 ( 2010-01), p. 65-76
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 1 ( 2010-01), p. 65-76
    Abstract: Background— Cardiac MRI is important in the treatment of children with congenital heart disease, but sufficient normative data are lacking. For ventricular volumes and mass, we sought to deliver reference centiles and to investigate sex effects. Methods and Results— We included 114 healthy children and adolescents, uniformly distributed spanning an age range of 4 to 20 years, as required by the Lambda-Mu-Sigma method to achieve a percentile distribution, thus avoiding arbitrary age categories. Subjects underwent axial volumetry (1.5-T scanner) using standardized 2D steady-state free-precession and flow protocols. Percentiles were computed for age 8 to 20 years (99 subjects) because breath-holds were more consistent in this group. When indexed for body surface area or height, the centile curves of ventricular volumetric parameters showed allometric increase until adolescence, when a plateau was reached, with values comparable to published adult reference data. In contrast, ventricular mass centiles increased without plateau. There was a significant sex difference, with centiles reflecting larger values in boys than in girls ( P 〈 0.05) when ventricular volumes were indexed to body surface area or height but not when indexed to weight (exception: mass). There was excellent agreement of axial and short-axis volumetry and of volumetric and flow-derived stroke volumes. Conclusions— Percentiles for ventricular volumes and mass in healthy children have been established to serve as reference values in pediatric heart disease. Significant sex differences were noted when indexing volumes to body surface area or height. Unisex centiles related to weight may be considered for chamber volumes albeit not for mass.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.109.859074
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
    detail.hit.zdb_id: 2440475-5
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  • 3
    Online Resource
    Online Resource
    Cardiac function by MRI in congenital heart disease: Impact of consensus training on interinstitutional variance
    Wiley ; 2009
    In:  Journal of Magnetic Resonance Imaging Vol. 30, No. 5 ( 2009-11), p. 956-966
    Details
    In: Journal of Magnetic Resonance Imaging, Wiley, Vol. 30, No. 5 ( 2009-11), p. 956-966
    Abstract: To investigate the impact of interinstitutional variance (=interobserver variance between institutions) for volumetric and flow cardiac MR (CMR) data and if training on image reading could improve bias. Materials and Methods: In a three‐center study, a total of 32 adults with repaired Tetralogy of Fallot and 23 controls underwent CMR using standardized protocols for ventricular volumes/mass (by transverse and short‐axis cine‐MRI) and pulmonary/aortic blood flow by velocity‐encoded MRI (VEC‐MRI). Data were analyzed blinded and independently in each institution by experienced readers. Interinstitutional variance was determined before/after training on consented guidelines for image analysis. Results: In patients, initial interinstitutional variability of right ventricular parameters was substantial but decreased by training. On transverse planes, variation coefficient for end‐diastolic/systolic volumes and ejection fraction decreased from 22%, 19%, and 19% to 7%, 10%, and 8%, respectively ( P 〈 0.025). Left‐ventricular variation coefficients improved for end‐diastolic and stroke volumes from 8% and 15% to 4% and 6%, respectively ( P 〈 0.007). For short‐axis volumetry training resulted in narrowed limits of confidence. Variability did not significantly change in the controls. There was no significant difference between transverse/short‐axis MRI. Interinstitutional variance for VEC‐MRI in patients/controls was low ( 〈 4%). Conclusion: Interinstitutional variance is an important source of variability in volumetric but not in flow CMR. Such variance can be reduced effectively by consented training. J. Magn. Reson. Imaging 2009;30:956–966. © 2009 Wiley‐Liss, Inc.
    Type of Medium: Online Resource
    ISSN: 1053-1807 , 1522-2586
    URL: Issue
    URL: Article
    DOI: 10.1002/jmri.v30:5
    DOI: 10.1002/jmri.21948
    Language: English
    Publisher: Wiley
    Publication Date: 2009
    detail.hit.zdb_id: 1497154-9
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