@Article{,
AUTHOR = {Richard J. Dobson, Ify Mordi, Mark H. Danton, Niki L. Walker, Hamish A. Walker, Nikolaos Tzemos},
TITLE = {Late gadolinium enhancement and adverse outcomes in a contemporary cohort of adult survivors of tetralogy of Fallot},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {12},
YEAR = {2017},
NUMBER = {1},
PAGES = {58--66},
URL = {http://www.techscience.com/schd/v12n1/38721},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Myocardial fibrosis has been associated with poorer outcomes in tetralogy of Fallot, however only a handful of studies have assessed its significance in the current era. Our aim was to quantify
the amount of late gadolinium enhancement in both the LV and RV in a contemporary cohort of adults
with surgically repaired tetralogy of Fallot, and assess the relationship with adverse clinical outcomes.<br/>
<b>Design:</b> Single centre cohort study<br/>
<b>Setting:</b> National tertiary referral center<br/>
<b>Patients:</b> One hundred fourteen patients with surgically repaired tetralogy of Fallot with median
age 29.5 years (range 17.5-64.2). Prospective follow-up for mean 2.4 years (SD 1.29).<br/>
<b>Interventions:</b> Cardiovascular magnetic resonance was performed, and late gadolinium enhancement mass was estimated for the LV using the 5-SD remote myocardium method, and for the RV
using a segmental scoring system. Cohort characterization was determined through the use of a
computerized database.<br/>
<b>Outcome measures:</b> Survival analysis from time of scan to first adverse event, defined as an episode of atrial arrhythmia, sustained ventricular arrhythmia, hospitalization with heart failure, or
implantable cardioverter-defibrillator insertion.<br/>
<b>Results:</b> Eleven patients experienced an adverse outcome in the follow-up period, although there were
no deaths. LV late gadolinium enhancement was associated with adverse outcomes in a univariate model
(P = .027). However, when adjusted for age at scan the significant variables included NYHA class
(P = .006), peak oxygen uptake (P = .028), number of prior sternotomies (P = .044), and higher indexed
RV and LV end diastolic volumes (P = .002 and P< .001), but not RV or LV late gadolinium enhancement.<br/>
<b>Conclusions:</b> Formal quantification of late gadolinium enhancement is not currently as helpful in ascertaining prognosis compared to other, more easily assessed parameters in a contemporary cohort of
tetralogy of Fallot survivors, however assessment particularly of the LV holds promise for the future.},
DOI = {}
}