Abstract 20320: Late Gadolinium Enhancement at Interventricular Insertion Point Strongly Predicts Systolic and Diastolic Dysfunction of the Systemic Ventricle in Repaired Adult Patients With Complex Congenital Heart Disease
Background: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) at interventricular insertion points can often be detected in patients with hypertrophic cardiomyopathy. Some adult patients with congenital heart disease (ACHD) would also show the findings. They were, however, thought to be non-specific, ubiquitous findings, and their clinical importance have not been well analyzed.
Methods: We studied 104 consecutive postoperative adult patients with complex congenital heart disease with biventricular physiology (18-67 years; mean age 32 years, including 55 patients with tetralogy of Fallot, 36 men). Ventricular short-axis images obtained by CMR presenting locations of LGE were analyzed. We calculated the signal-intensity ratio (SIR) of interventricular insertion points to the adjacent blood cavity and averaged them in series of slices. We also measured the end-diastolic, end-systolic ventricular volume and myocardial mass standardized by body surface area (EDVI, ESVI, Mass-I) and ejection fraction (EF) of the left and right ventricle (LV, RV) by CMR. We compared the SIR with clinical profiles, including hemodynamic parameters in cardiac catheterization (for example, end-diastolic ventricular pressure, EDP, pulmonary capillary wedge pressure, PCWP).
Results: Seventy-six patients (72%) had the LGE at interventricular insertion points, located at anterior, posterior or both side of septum in 8, 42 and 26 patients respectively. In univariate analysis, the SIR showed positive correlation with LVEDVI (r = 0.22, p = 0.029), LVESVI (r = 0.29, p = 0.004), LVEDP (r = 0.27, p = 0.010), PCWP (r = 0.24, p = 0.025), QRS duration (r = 0.22, p = 0.030), and negative correlation with LVEF (r = -0.24, p = 0.019). In multivariate analysis, LVESVI (p = 0.003), LVEDP (p = 0.011), QRS duration (p = 0.014), and cardiac index (p = 0.034) were independently correlated with the SIR.
Conclusion: In postoperative complex ACHD with biventricular physiology, the patients often show the LGE at interventricular insertion points. And their elevated signal intensity strongly predicts systolic and diastolic dysfunction of the systemic ventricle.
Author Disclosures: Y. Hayama: None. H. Ohuchi: None. J. Negishi: None. K. Noritake: None. T. Iwasa: None. A. Miyazaki: None. E. Tsuda: None. I. Shiraishi: None.
- © 2016 by American Heart Association, Inc.