TY - JOUR
T1 - Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement
AU - Yamamura, Kenichiro
AU - Yuen, Darren
AU - Hickey, Edward J.
AU - He, Xiaolin
AU - Chaturvedi, Rajiv R.
AU - Friedberg, Mark K.
AU - Grosse-Wortmann, Lars
AU - Hanneman, Kate
AU - Billia, Filio
AU - Farkouh, Michael E.
AU - Wald, Rachel M.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objective The relationship between right ventricular (RV) fibrosis and right heart reverse remodelling following pulmonary valve replacement (PVR) has not been well studied in adults with repaired tetralogy of Fallot (rTOF). Our aims were to histologically quantify RV fibrosis and to explore the relationship between fibrosis severity and cardiac remodelling post-PVR. Methods Adults with rTOF and pre-PVR cardiovascular (CMR) imaging were consented to procurement of RV muscle during PVR. Samples were stained with picrosirius red to quantify collagen volume fraction. Clinical data at baseline and at last follow-up were reviewed. Adverse cardiovascular outcomes included death, sustained arrhythmia and heart failure. Results Fifty-three patients (male 58%, 38±11 years) were studied. Those with severe fibrosis (collagen volume fraction >11.0%, n=13) had longer aortic cross-clamp times at initial repair compared with the remainder of the population (50 vs 33 min, p=0.018) and increased RV mass:volume ratio pre-PVR (0.20 vs 0.18 g/mL, p=0.028). Post-PVR, the severe fibrosis group had increased indexed RV end-systolic volume index (RVESVi) (74 vs 66 mL/m 2, p=0.044), decreased RVESVi change (I "29 vs I "45 mL/m 2, p=0.005), increased RV mass (34 vs 25 g/m 2, p=0.023) and larger right atrial (RA) area (21 vs 17 cm 2, p=0.021). A trend towards increased heart failure events was observed in the severe fibrosis group (15% vs 0%, p=0.057). Conclusions Severe RV fibrosis was associated with increased RVESVi, RV mass and RA area post-PVR in rTOF. Further study is required to define the impact of fibrosis and persistent right heart enlargement on clinical outcomes.
AB - Objective The relationship between right ventricular (RV) fibrosis and right heart reverse remodelling following pulmonary valve replacement (PVR) has not been well studied in adults with repaired tetralogy of Fallot (rTOF). Our aims were to histologically quantify RV fibrosis and to explore the relationship between fibrosis severity and cardiac remodelling post-PVR. Methods Adults with rTOF and pre-PVR cardiovascular (CMR) imaging were consented to procurement of RV muscle during PVR. Samples were stained with picrosirius red to quantify collagen volume fraction. Clinical data at baseline and at last follow-up were reviewed. Adverse cardiovascular outcomes included death, sustained arrhythmia and heart failure. Results Fifty-three patients (male 58%, 38±11 years) were studied. Those with severe fibrosis (collagen volume fraction >11.0%, n=13) had longer aortic cross-clamp times at initial repair compared with the remainder of the population (50 vs 33 min, p=0.018) and increased RV mass:volume ratio pre-PVR (0.20 vs 0.18 g/mL, p=0.028). Post-PVR, the severe fibrosis group had increased indexed RV end-systolic volume index (RVESVi) (74 vs 66 mL/m 2, p=0.044), decreased RVESVi change (I "29 vs I "45 mL/m 2, p=0.005), increased RV mass (34 vs 25 g/m 2, p=0.023) and larger right atrial (RA) area (21 vs 17 cm 2, p=0.021). A trend towards increased heart failure events was observed in the severe fibrosis group (15% vs 0%, p=0.057). Conclusions Severe RV fibrosis was associated with increased RVESVi, RV mass and RA area post-PVR in rTOF. Further study is required to define the impact of fibrosis and persistent right heart enlargement on clinical outcomes.
KW - cardiac magnetic resonance (cmr) imaging
KW - congenital heart disease surgery
KW - tetralogy of fallot
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U2 - 10.1136/heartjnl-2018-313961
DO - 10.1136/heartjnl-2018-313961
M3 - Article
C2 - 30514732
AN - SCOPUS:85058063304
SN - 1355-6037
VL - 105
SP - 855
EP - 863
JO - Heart
JF - Heart
IS - 11
ER -