Left Ventricular Longitudinal Function Predicts Life-Threatening Ventricular Arrhythmia and Death in Adults with Repaired Tetralogy of Fallot
Background—Sudden cardiac death and life-threatening ventricular arrhythmias (SCD/LTA) remain a concern in adult patients with repaired tetralogy of Fallot (ToF). Longitudinal left ventricular (LV) function is sensitive in detecting early myocardial damage and may have prognostic implications in this setting.
Methods and Results—We included 413 ToF patients (age 36±13years, QRS duration 148±27ms, LV-EF 55±10%). A composite endpoint of SCD/LTA (sustained ventricular tachycardia, resuscitated SCD or appropriate ICD discharge) was employed. During a median follow-up of 2.9 years 5 patients died suddenly, 9 had documented sustained VT and another 5 had appropriate ICD shocks. On univariate Cox analysis QRS-duration (hazard ratio [HR] 1.02/ms, P=0.046), right atrial area (HR 1.05/cm2, P=0.02), right ventricular (RV) fractional area change (HR 0.94/%, P=0.02), RV outflow tract diameter (HR 1.08/mm, P=0.01), mitral annular plane systolic excursion (MAPSE, HR 0.84/mm, P=0.03) and LV global longitudinal 2-dimensional strain (LV-LS, HR 0.87/%, P=0.03) were related to the combined endpoint. On bivariable analysis MAPSE and LV-LS were related to outcome independently of QRS-duration (P=0.002 and P=0.01, respectively). In addition, a combination of echocardiographic variables including right atrial area and RV fractional area change as well as LV-LS or MAPSE was also found to be significantly related to outcome (P<0.001, c-statistic 0.70).
Conclusions—Left ventricular longitudinal dysfunction was associated with greater risk of SCD/LTA. In combination with echocardiographic right heart variables, also available from routine echocardiography, these measures provide important outcome information and should be considered a useful adjunct to established markers such as QRS-duration when estimating prognosis in this challenging population.
- adult congenital heart disease
- risk stratification
- Tetralogy of Fallot
- sudden cardiac death
- Received December 14, 2011.
- Accepted March 22, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited