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Assessment of Diffuse Ventricular Myocardial Fibrosis Using Native T1 in Children With Repaired Tetralogy of Fallot.
Circ Cardiovasc Imaging. 2017 03; 10(3)CC

Abstract

BACKGROUND

Myocardial fibrosis is linked with adverse clinical outcomes in adults after tetralogy of Fallot repair (rTOF). Native T1 times (T1) by cardiac magnetic resonance have been shown to be a surrogate marker of diffuse myocardial fibrosis. The objective was to quantify native T1 in children post-rTOF and to evaluate their relationship with surgical, imaging, and clinical factors.

METHODS AND RESULTS

A retrospective cross-sectional study was performed. Midventricular native T1 were obtained in 100 children post-rTOF using a modified look-locker inversion recovery cardiac magnetic resonance sequence and compared with 35 pediatric controls. rTOF patients, aged 13.0±2.9 years, had higher indexed right ventricular (RV) end-diastolic (range 85-326 mL/m2, mean 148 mL/m2) volumes, and lower RV and left ventricular (LV) ejection fractions compared with controls. RV, but not LV, T1 were higher in patients than in controls (1031±74 versus 954±32 ms, P<0.001) and female patients had higher RV T1 compared with males (1051±79 versus 1017±68 ms, P=0.02). LV T1 correlated with RV T1 (r=0.45, P<0.001), cardiopulmonary bypass (r=0.30, P=0.007), and aortic cross-clamp times (r=0.32, P=0.004). RV T1 correlated inversely with RV outflow tract gradient (r=-0.28, P=0.02). Longer aortic cross-clamp times were independently associated with LV and RV T1 on multivariable analysis. There was no association between exercise intolerance, arrhythmia, and native T1 or LV extracellular volume.

CONCLUSIONS

Children after rTOF do not have elevated LV native T1 or LV extracellular volume, but show evidence of increased RV native T1 suggestive of diffuse RV fibrosis, for which volume loading seems to be a risk factor. Surgical bypass and cross-clamp times are associated with fibrotic remodeling over a decade later.

Authors+Show Affiliations

From the Division of Pediatric Cardiology, Department of Pediatrics (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.) and Department of Diagnostic Imaging (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada.From the Division of Pediatric Cardiology, Department of Pediatrics (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.) and Department of Diagnostic Imaging (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada.From the Division of Pediatric Cardiology, Department of Pediatrics (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.) and Department of Diagnostic Imaging (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada.From the Division of Pediatric Cardiology, Department of Pediatrics (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.) and Department of Diagnostic Imaging (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada.From the Division of Pediatric Cardiology, Department of Pediatrics (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.) and Department of Diagnostic Imaging (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada.From the Division of Pediatric Cardiology, Department of Pediatrics (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.) and Department of Diagnostic Imaging (D.Y., E.R., P.C.-D., S.-J.Y., M.S., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada. Lars.Grosse-Wortmann@sickkids.ca.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28292861

Citation

Yim, Deane, et al. "Assessment of Diffuse Ventricular Myocardial Fibrosis Using Native T1 in Children With Repaired Tetralogy of Fallot." Circulation. Cardiovascular Imaging, vol. 10, no. 3, 2017.
Yim D, Riesenkampff E, Caro-Dominguez P, et al. Assessment of Diffuse Ventricular Myocardial Fibrosis Using Native T1 in Children With Repaired Tetralogy of Fallot. Circ Cardiovasc Imaging. 2017;10(3).
Yim, D., Riesenkampff, E., Caro-Dominguez, P., Yoo, S. J., Seed, M., & Grosse-Wortmann, L. (2017). Assessment of Diffuse Ventricular Myocardial Fibrosis Using Native T1 in Children With Repaired Tetralogy of Fallot. Circulation. Cardiovascular Imaging, 10(3). https://doi.org/10.1161/CIRCIMAGING.116.005695
Yim D, et al. Assessment of Diffuse Ventricular Myocardial Fibrosis Using Native T1 in Children With Repaired Tetralogy of Fallot. Circ Cardiovasc Imaging. 2017;10(3) PubMed PMID: 28292861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of Diffuse Ventricular Myocardial Fibrosis Using Native T1 in Children With Repaired Tetralogy of Fallot. AU - Yim,Deane, AU - Riesenkampff,Eugenie, AU - Caro-Dominguez,Pablo, AU - Yoo,Shi-Joon, AU - Seed,Mike, AU - Grosse-Wortmann,Lars, PY - 2016/06/30/received PY - 2017/01/12/accepted PY - 2017/3/16/entrez PY - 2017/3/16/pubmed PY - 2017/5/10/medline KW - children KW - fibrosis KW - magnetic resonance imaging KW - myocardial KW - tetralogy of Fallot JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 10 IS - 3 N2 - BACKGROUND: Myocardial fibrosis is linked with adverse clinical outcomes in adults after tetralogy of Fallot repair (rTOF). Native T1 times (T1) by cardiac magnetic resonance have been shown to be a surrogate marker of diffuse myocardial fibrosis. The objective was to quantify native T1 in children post-rTOF and to evaluate their relationship with surgical, imaging, and clinical factors. METHODS AND RESULTS: A retrospective cross-sectional study was performed. Midventricular native T1 were obtained in 100 children post-rTOF using a modified look-locker inversion recovery cardiac magnetic resonance sequence and compared with 35 pediatric controls. rTOF patients, aged 13.0±2.9 years, had higher indexed right ventricular (RV) end-diastolic (range 85-326 mL/m2, mean 148 mL/m2) volumes, and lower RV and left ventricular (LV) ejection fractions compared with controls. RV, but not LV, T1 were higher in patients than in controls (1031±74 versus 954±32 ms, P<0.001) and female patients had higher RV T1 compared with males (1051±79 versus 1017±68 ms, P=0.02). LV T1 correlated with RV T1 (r=0.45, P<0.001), cardiopulmonary bypass (r=0.30, P=0.007), and aortic cross-clamp times (r=0.32, P=0.004). RV T1 correlated inversely with RV outflow tract gradient (r=-0.28, P=0.02). Longer aortic cross-clamp times were independently associated with LV and RV T1 on multivariable analysis. There was no association between exercise intolerance, arrhythmia, and native T1 or LV extracellular volume. CONCLUSIONS: Children after rTOF do not have elevated LV native T1 or LV extracellular volume, but show evidence of increased RV native T1 suggestive of diffuse RV fibrosis, for which volume loading seems to be a risk factor. Surgical bypass and cross-clamp times are associated with fibrotic remodeling over a decade later. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/28292861/Assessment_of_Diffuse_Ventricular_Myocardial_Fibrosis_Using_Native_T1_in_Children_With_Repaired_Tetralogy_of_Fallot_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.116.005695?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -