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...

Full description

Bibliographic Details
Main Authors: Maria Fadous, Maria-Victoria Ordoñez, Carlos-Eduardo Guerrero-Chalela, Aihua Liu, Liming Guo, Luc Jutras, Ariane J. Marelli, Judith Therrien
Format: Article
Language:English
Published: Elsevier 2021-10-01
Series:International Journal of Cardiology Congenital Heart Disease
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2666668521001464
id doaj-f1d83ec3388b4b91ad2023e2233a5fc5
record_format Article
spelling doaj-f1d83ec3388b4b91ad2023e2233a5fc52021-09-25T05:11:58ZengElsevierInternational Journal of Cardiology Congenital Heart Disease2666-66852021-10-015100222Cardiac index in adults with repaired tetralogy of Fallot: Are we missing the forest for the trees?Maria Fadous0Maria-Victoria Ordoñez1Carlos-Eduardo Guerrero-Chalela2Aihua Liu3Liming Guo4Luc Jutras5Ariane J. Marelli6Judith Therrien7McGill University, Montreal, CanadaBeth Raby Adult Congenital Heart Disease Clinic, Jewish General Hospital, Montreal, Canada; McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, CanadaBeth Raby Adult Congenital Heart Disease Clinic, Jewish General Hospital, Montreal, Canada; McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, CanadaMcGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, CanadaMcGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, CanadaMontreal Children's Hospital, Montreal, CanadaMcGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, CanadaBeth Raby Adult Congenital Heart Disease Clinic, Jewish General Hospital, Montreal, Canada; McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Canada; Corresponding author. McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada.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.http://www.sciencedirect.com/science/article/pii/S2666668521001464Cardiac indexCardiac magnetic resonance imagingAdult congenital heart diseaseTetralogy of Fallot
collection DOAJ
language English
format Article
sources DOAJ
author Maria Fadous
Maria-Victoria Ordoñez
Carlos-Eduardo Guerrero-Chalela
Aihua Liu
Liming Guo
Luc Jutras
Ariane J. Marelli
Judith Therrien
spellingShingle 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?
International Journal of Cardiology Congenital Heart Disease
Cardiac index
Cardiac magnetic resonance imaging
Adult congenital heart disease
Tetralogy of Fallot
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
series International Journal of Cardiology Congenital Heart Disease
issn 2666-6685
publishDate 2021-10-01
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.
topic Cardiac index
Cardiac magnetic resonance imaging
Adult congenital heart disease
Tetralogy of Fallot
url http://www.sciencedirect.com/science/article/pii/S2666668521001464
work_keys_str_mv AT mariafadous cardiacindexinadultswithrepairedtetralogyoffallotarewemissingtheforestforthetrees
AT mariavictoriaordonez cardiacindexinadultswithrepairedtetralogyoffallotarewemissingtheforestforthetrees
AT carloseduardoguerrerochalela cardiacindexinadultswithrepairedtetralogyoffallotarewemissingtheforestforthetrees
AT aihualiu cardiacindexinadultswithrepairedtetralogyoffallotarewemissingtheforestforthetrees
AT limingguo cardiacindexinadultswithrepairedtetralogyoffallotarewemissingtheforestforthetrees
AT lucjutras cardiacindexinadultswithrepairedtetralogyoffallotarewemissingtheforestforthetrees
AT arianejmarelli cardiacindexinadultswithrepairedtetralogyoffallotarewemissingtheforestforthetrees
AT judiththerrien cardiacindexinadultswithrepairedtetralogyoffallotarewemissingtheforestforthetrees
_version_ 1717368850309185536