Abstract 15453: QRS Fragmentation is Associated With Right Ventricular Failure in Adults With Tetralogy of Fallot
Introduction: Limited data is available to identify tetralogy of Fallot (TOF) patients at risk for right ventricular (RV) function deterioration and subsequent heart failure. Recently, fragmentation of QRS complexes (fQRS) was related to RV fibrosis and all-cause mortality. Our objective was to determine whether fQRS was associated with RV failure.
Methods: This dual center study included all adult TOF patients with at least one cardiovascular magnetic resonance (CMR) investigation from a prospective registry. Notches in the QRS complex in ≥2 contiguous leads on a standard 12-lead electrocardiogram (ECG), not related to right bundle branch block, were defined as fQRS (figure A). Cox hazards regression was used to determine variables associated with the primary outcome heart failure (increase NYHA class requiring diuretics) or death. For patients with multiple CMR examinations, predictors of RV ejection fraction (EF) deterioration were determined with mixed linear models.
Results: A total of 276 TOF patients (age at inclusion: 33±12 years, 55% male, 8.9±3.4 years follow-up, QRS fragmentation in 45%) were included. Baseline RV EF was 49±9% and LV EF was 52±7%. A total of 23 patients had heart failure (n=18) or died from other reasons. In 206 patients with multiple CMRs (total 621), yearly change of RV EF was +0.29% and yearly change of LV EF was +0.20%. In bivariate analysis, a combination of baseline RV EF (HR: 0.90, 95%C.I.:0.85-0.95, p<0.001) and RV EF deterioration (HR: 0.83, 95%C.I.:0.73-0.94, p=0.004) was associated with heart failure/death. QRS fragmentation was the only factor associated with RV EF deterioration (β:-0.60% yearly, 95%C.I.:-1.0, -0.2, p=0.006), corrected for baseline RV EF.
Conclusions: In adult TOF patients, RV EF deterioration was independently predictive for heart failure/death. QRS fragmentation was the only factor associated with RV deterioration. These findings may improve selection of patients for therapy to prevent heart failure.
Author Disclosures: J.P. Bokma: None. M.M. Winter: None. K.C. de Wilde: None. H.W. Vliegen: None. M. Groenink: None. B.J. Mulder: None. B.J. Bouma: None.
- © 2016 by American Heart Association, Inc.