Imperial College London
Alternate

ProfessorDudleyPennell

Faculty of Medicine, National Heart & Lung Institute

Professor of Cardiology
 
 
 
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Contact

 

+44 (0)20 7351 8810d.pennell

 
 
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Location

 

CMR UnitRoyal BromptonRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Ghonim:2022:10.1016/j.jcmg.2021.07.026,
author = {Ghonim, S and Gatzoulis, M and Ernst, S and Li, W and Moon, J and Smith, G and Heng, EL and Keegan, J and Ho, SY and McCarthy, KP and Shore, D and Uebing, A and Kempny, A and Alpendurada, F and Dimopoulos, K and Pennell, DJ and Babu-Narayan, S},
doi = {10.1016/j.jcmg.2021.07.026},
journal = {JACC: Cardiovascular Imaging},
pages = {257--268},
title = {Predicting survival in repaired tetralogy of Fallot- a lesion specific  and personalised approach},
url = {http://dx.doi.org/10.1016/j.jcmg.2021.07.026},
volume = {15},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective: We sought to identifyrepaired tetralogy of Fallot (rTOF) patients at high-risk of death and malignant ventricular arrhythmia (VA). Background: To date there is no robust risk stratification scheme to predict outcomes in adults with rTOF. Methods: Consecutive patients were prospectively recruited for late gadolinium enhancement cardiovascular magnetic resonance (LGE CMR) to define right and left ventricular (RV,LV) fibrosisin addition to proven risk markers. Results: The primary end-point was all-cause mortality. Of the 550 patients, (median age 32 years, 56% male), 27 died (mean follow-up 6.4 (±5.8); total 3512 years). Mortality was independently predicted by RVLGE extent, presence of LVLGE, RV ejection fraction (EF) ≤47%, LVEF ≤55%, B-type natriuretic peptide (BNP) ≥127ng/L, peak exercise oxygen uptake (V02) ≤17ml/kg/min, prior sustained atrial arrhythmia and age ≥50 years. The weighted scores for each of the above independent predictors differentiated a high-risk sub-group patients with a 4.4%, annual risk of mortality (AUC 0.87,P<0.001). The secondary end-point (VA), a composite of life-threatening sustained ventricular tachycardia/resuscitated ventricular fibrillation/sudden cardiac death occurred in 29. Weighted scores that included several predictors of mortality and RV outflow tractakinetic length ≥55mm and RVsystolic pressure ≥47mm Hg identified high-risk patients with a 3.7%, annual risk ofVA (AUC 0.79,P<0.001) RVLGE was heavily weighted in both risk scores due to its strong relative prognostic value. Conclusion: We present ascore integrating multiple appropriately weighted risk factors to identify the sub-group of rTOF patients that are at highannual risk of death who may benefit from targeted therapy.
AU  - Ghonim,S
AU  - Gatzoulis,M
AU  - Ernst,S
AU  - Li,W
AU  - Moon,J
AU  - Smith,G
AU  - Heng,EL
AU  - Keegan,J
AU  - Ho,SY
AU  - McCarthy,KP
AU  - Shore,D
AU  - Uebing,A
AU  - Kempny,A
AU  - Alpendurada,F
AU  - Dimopoulos,K
AU  - Pennell,DJ
AU  - Babu-Narayan,S
DO  - 10.1016/j.jcmg.2021.07.026
EP  - 268
PY  - 2022///
SN  - 1876-7591
SP  - 257
TI  - Predicting survival in repaired tetralogy of Fallot- a lesion specific  and personalised approach
T2  - JACC: Cardiovascular Imaging
UR  - http://dx.doi.org/10.1016/j.jcmg.2021.07.026
UR  - https://www.sciencedirect.com/science/article/pii/S1936878X21006318?via%3Dihub
UR  - http://hdl.handle.net/10044/1/91643
VL  - 15
ER  -
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