Prognostic value of myocardial deformation parameters for outcome prediction in tetralogy of Fallot

Subin K Thomas; Romina DSouza; Kate Hanneman; Gauri R Karur; Christian Houbois; Ayako Ishikita; Luigia D'Errico; Isaac Begun; Ming-Yen Ng; Rachel M Wald

doi:10.1016/j.jocmr.2024.101054

Prognostic value of myocardial deformation parameters for outcome prediction in tetralogy of Fallot

J Cardiovasc Magn Reson. 2024 Jul 1;26(2):101054. doi: 10.1016/j.jocmr.2024.101054. Online ahead of print.

Authors

Affiliations

¹ Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
² Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
³ Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong; Department of Medical Imaging, The University of Hong-Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
⁵ Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: rachel.wald@uhn.ca.

Abstract

Background: The prognostic value of myocardial deformation parameters in adults with repaired tetralogy of Fallot (rTOF) has not been well-elucidated. We therefore aimed to explore myocardial deformation parameters for outcome prediction in adults with rTOF using cardiovascular magnetic resonance imaging (CMR).

Methods: Adults with rTOF and at least moderate pulmonary regurgitation were identified from an institutional prospective CMR registry. Left ventricular (LV) and right ventricular (RV) global strains were recorded in longitudinal (GLS), circumferential (GCS), and radial (GRS) directions. Major adverse cardiovascular events (MACE) were defined as a composite of mortality, resuscitated sudden death, sustained ventricular tachycardia (>30 seconds), or heart failure (hospital admission >24 hours). In patients with pulmonary valve replacement (PVR), pre- and post-PVR CMR studies were analyzed to assess for predictors of complete RV reverse remodeling, defined as indexed RV end-diastolic volume (RVEDVi) <110 mL/m². Logistic regression models were used to estimate the odds ratio (OR) per unit change in absolute strain value associated with clinical outcomes and receiver operator characteristic curves were constructed with area under the curve (AUC) for select CMR variables.

Results: We included 307 patients (age 35 ± 13 years, 59% (180/307) male). During 6.1 years (3.3-8.8) of follow-up, PVR was performed in 142 (46%) and MACE occurred in 31 (10%). On univariate analysis, baseline biventricular ejection fraction (EF), mass, and all strain parameters were associated with MACE. After adjustment for LVEF, only LV-GLS remained independently predictive of MACE (OR 0.822 [0.693-0.976] p = 0.025). Receiver operator curves identified an absolute LV-GLS value less than 15 and LVEF less than 51% as thresholds for MACE prediction (AUC 0.759 [0.655-0.840] and 0.720 [0.608-0.810]). After adjusting for baseline RVEDVi, RV-GCS (OR 1.323 [1.094-1.600] p = 0.004), LV-GCS (OR 1.276 [1.029-1.582] p = 0.027) and LV-GRS (OR 1.101 [1.0210-1.200], p = 0.028) were independent predictors of complete remodeling post-PVR remodeling.

Conclusion: Biventricular strain parameters predict clinical outcomes and post-PVR remodeling in rTOF. Further study will be necessary to establish the role of myocardial deformation parameters in clinical practice.

Keywords: Cardiovascular magnetic resonance imaging; Myocardial deformation; Outcomes; Strain; Tetralogy of Fallot.