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Optimal follow-up in adult patients with congenital heart disease and chronic pulmonary regurgitation: towards tailored use of cardiac magnetic resonance imaging.
Arch Cardiovasc Dis. 2013 Jan; 106(1):27-35.AC

Abstract

BACKGROUND

Pulmonary regurgitation (PR) is a common complication of right ventricular outflow tract (RVOT) reconstruction and leads to right ventricular (RV) dilatation and dysfunction. Although cardiac magnetic resonance (CMR) is the gold standard for evaluating PR and RV dysfunction, cost and limited availability are problems in many centres.

AIMS

To determine clinical, electrocardiographic and echocardiographic predictors of these complications and optimize patient selection for their short-term follow-up by CMR.

METHODS

Ninety-four patients with a history of RVOT repair were prospectively included. All patients had a clinical examination, electrocardiography, echocardiography and CMR.

RESULTS

QRS duration, indexed end-diastolic RV (EDRV) diameter and area on echocardiography were significantly associated with RV dilatation on CMR (P<0.001). The distal localization of Doppler PR flow was the strongest echocardiographic criterion associated with severe PR (P<0.001). Arrhythmia history and high Tei index were significantly associated with low RV ejection fraction (P<0.001 and P=0.017, respectively). In multivariable analysis, grade of PR, QRS duration, arrhythmia and valvulotomy were strongly associated with severe PR and RV dilatation or systolic RV dysfunction. From these results, an approach based on a scaled scoring system for selecting patients who need short-term CMR evaluation and close follow-up was evaluated. This method should avoid 31% of CMR examinations, with a sensitivity of 97.7%.

CONCLUSION

Clinical, electrocardiographic and echocardiographic criteria can be used to accurately evaluate patients with RVOT repair. The combination of such features facilitates identification of patients who do or do not require close CMR evaluation.

Authors+Show Affiliations

Department of Paediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C, Necker Hospital, Université Paris Descartes, France. magalie.ladouceur@egp.aphp.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23374969

Citation

Ladouceur, Magalie, et al. "Optimal Follow-up in Adult Patients With Congenital Heart Disease and Chronic Pulmonary Regurgitation: Towards Tailored Use of Cardiac Magnetic Resonance Imaging." Archives of Cardiovascular Diseases, vol. 106, no. 1, 2013, pp. 27-35.
Ladouceur M, Gillaizeau F, Redheuil A, et al. Optimal follow-up in adult patients with congenital heart disease and chronic pulmonary regurgitation: towards tailored use of cardiac magnetic resonance imaging. Arch Cardiovasc Dis. 2013;106(1):27-35.
Ladouceur, M., Gillaizeau, F., Redheuil, A., Iserin, L., Bonnet, D., Boudjemline, Y., & Mousseaux, E. (2013). Optimal follow-up in adult patients with congenital heart disease and chronic pulmonary regurgitation: towards tailored use of cardiac magnetic resonance imaging. Archives of Cardiovascular Diseases, 106(1), 27-35. https://doi.org/10.1016/j.acvd.2012.10.003
Ladouceur M, et al. Optimal Follow-up in Adult Patients With Congenital Heart Disease and Chronic Pulmonary Regurgitation: Towards Tailored Use of Cardiac Magnetic Resonance Imaging. Arch Cardiovasc Dis. 2013;106(1):27-35. PubMed PMID: 23374969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimal follow-up in adult patients with congenital heart disease and chronic pulmonary regurgitation: towards tailored use of cardiac magnetic resonance imaging. AU - Ladouceur,Magalie, AU - Gillaizeau,Florence, AU - Redheuil,Alban, AU - Iserin,Laurence, AU - Bonnet,Damien, AU - Boudjemline,Younes, AU - Mousseaux,Elie, Y1 - 2012/12/25/ PY - 2012/07/06/received PY - 2012/09/28/revised PY - 2012/10/09/accepted PY - 2013/2/5/entrez PY - 2013/2/5/pubmed PY - 2013/7/28/medline SP - 27 EP - 35 JF - Archives of cardiovascular diseases JO - Arch Cardiovasc Dis VL - 106 IS - 1 N2 - BACKGROUND: Pulmonary regurgitation (PR) is a common complication of right ventricular outflow tract (RVOT) reconstruction and leads to right ventricular (RV) dilatation and dysfunction. Although cardiac magnetic resonance (CMR) is the gold standard for evaluating PR and RV dysfunction, cost and limited availability are problems in many centres. AIMS: To determine clinical, electrocardiographic and echocardiographic predictors of these complications and optimize patient selection for their short-term follow-up by CMR. METHODS: Ninety-four patients with a history of RVOT repair were prospectively included. All patients had a clinical examination, electrocardiography, echocardiography and CMR. RESULTS: QRS duration, indexed end-diastolic RV (EDRV) diameter and area on echocardiography were significantly associated with RV dilatation on CMR (P<0.001). The distal localization of Doppler PR flow was the strongest echocardiographic criterion associated with severe PR (P<0.001). Arrhythmia history and high Tei index were significantly associated with low RV ejection fraction (P<0.001 and P=0.017, respectively). In multivariable analysis, grade of PR, QRS duration, arrhythmia and valvulotomy were strongly associated with severe PR and RV dilatation or systolic RV dysfunction. From these results, an approach based on a scaled scoring system for selecting patients who need short-term CMR evaluation and close follow-up was evaluated. This method should avoid 31% of CMR examinations, with a sensitivity of 97.7%. CONCLUSION: Clinical, electrocardiographic and echocardiographic criteria can be used to accurately evaluate patients with RVOT repair. The combination of such features facilitates identification of patients who do or do not require close CMR evaluation. SN - 1875-2128 UR - https://www.unboundmedicine.com/medline/citation/23374969/Optimal_follow_up_in_adult_patients_with_congenital_heart_disease_and_chronic_pulmonary_regurgitation:_towards_tailored_use_of_cardiac_magnetic_resonance_imaging_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1875-2136(12)00294-X DB - PRIME DP - Unbound Medicine ER -