Abstract 17881: Indexed Ventricular End Diastolic Volume, Ejection Fraction, and QRS Duration Can Be Predictive of Future Cardiac Events and Associated With Interventricular Dyssynchrony in the Fontan Patients With Biventricular Heart
Introduction: The prognostic factors in patients with biventricular heart who underwent Fontan operation remain unclear.
Hypothesis: We assessed the hypothesis that ventricular dilatation, ventricular dysfunction, and prolonged QRS duration can be predictive of future cardiac events in Fontan patients with biventricular heart.
Methods: We prospectively enrolled consecutive patients with biventricular Fontan circulation from 2003 to 2016, and performed protocolized cardiac MRI. To assess the interventricular dyssynchrony, we determined the stroke volume ratio (SVR) by using the following formula: [stroke volume (SV) of two whole ventricles] / (SV of right ventricle + SV of left ventricle), by tracing cine MRI data. If interventricular dyssynchrony existed, the blood flowed and returned to each ventricle through the VSD; therefore, the SVR should be less than 1.0. Moreover, we investigated QRS duration on medical records.
Results: A total of 40 patients were enrolled. During the follow-up period (median, 49.5 months), 9 cardiovascular events occurred (5 cases of acute exacerbation of heart failure, 3 cases of supraventricular tachycardia, one case of exacerbation of protein-losing enteropathy). Univariate analysis showed four clinical predictors: SVR less than 0.95 (RR: 8.0, 95% CI: 1.1-58.2), indexed end diastolic volume (EDVi) of the whole ventricle more than 120 mL/m2 (RR: 3.8, 95% CI: 1.2-11.3), EF less than 0.45 (RR: 4.7, 95% CI: 1.1-20.0), and QRS duration more than 110 msec (RR: 2.1, 95% CI: 0.7-6.4). The clinical cut-off points were determined from the ROC curve. Combining the three former easy available clinically parameters, we categorized the patients as “low-risk group” (with no predictors, n=17), “intermediate-risk group” (with one or two predictors, n=21) and “high-risk group” (with all three predictors, n=2). The incidence rate of a cardiac event in each group was 0% (0/17), 33% (7/21), and 100% (2/2), respectively (p < 0.01). Moreover, median SVR was 0.99 [0.90-1.0], 0.92 [0.81-1.0] and 0.87 [0.86-0.89], respectively (p < 0.01).
Conclusions: The combination of EDVi, EF, and QRS duration can be predictive of the future cardiac events and is associated with interventricular dyssynchrony in Fontan patients with biventricular heart.
Author Disclosures: T. Takahashi: None. Y. Shiina: None. K. Inai: None. M. Nagao: None. K. Fukushima: None. H. Mori: None. G. Harada: None. E. Shimada: None. S. Asagai: None. M. Shimizu: None. T. Ishii: None. T. Shinohara: None. H. Sugiyama: None. H. Tomimatsu: None. I. Park: None.
- © 2016 by American Heart Association, Inc.