Imperial College London

DrSonyaBabu-Narayan

Faculty of MedicineNational Heart & Lung Institute

Reader in Adult Congenital Heart Disease
 
 
 
//

Contact

 

+44 (0)20 7351 8803s.babu-narayan

 
 
//

Location

 

NIHR Cardiovascular Biomedical RChelsea WingRoyal Brompton Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Geva:2018:10.1161/CIRCULATIONAHA.118.034740,
author = {Geva, T and Mulder, B and Gavreau, K and Babu-Narayan, SV and Wald, MD and Gatzoulis, M and Valente, AM and Hickey, K and Powell, AJ and Gatzoulis, MA},
doi = {10.1161/CIRCULATIONAHA.118.034740},
journal = {Circulation},
pages = {2106--2115},
title = {Preoperative predictors of death and sustained ventricular tachycardia after pulmonary valve replacement in patients with repaired tetralogy of fallot enrolled in the INDICATOR Cohort},
url = {http://dx.doi.org/10.1161/CIRCULATIONAHA.118.034740},
volume = {138},
year = {2018}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - Background -Risk factors for adverse clinical outcomes have been identified in patients with repaired tetralogy of Fallot (rTOF) before pulmonary valve replacement (PVR). However, pre-PVR predictors for post-PVR sustained ventricular tachycardia (VT) and death have not been identified. Methods -Patients with rTOF enrolled in the INDICATOR cohort-a 4-center international cohort study- who had a comprehensive preoperative evaluation and subsequently underwent PVR were included. Pre-procedural clinical, electrocardiogram, cardiovascular magnetic resonance (CMR), and postoperative outcome data were analyzed. Cox proportional hazards multivariable regression analysis was used to evaluate factors associated with time from pre-PVR CMR until the primary outcome-death, aborted sudden cardiac death, or sustained VT. Results -Of the 452 eligible patients (median age at PVR 25.8 years), 36 (8%) reached the primary outcome (27 deaths, 2 resuscitated death, and 7 sustained VT) at a median time after PVR of 6.5 years. Cox proportional hazards regression identified pre-PVR right ventricular (RV) ejection fraction < 40% (hazard ratio [HR] 2.39; 95% confidence interval [CI] 1.18 to 4.85; P = 0.02), RV mass-to-volume ratio ≥ 0.45 g/mL (HR 4.08; 95%, CI 1.57 to 10.6; P = 0.004), and age at PVR ≥ 28 years (HR 3.10; 95% CI 1.42 to 6.78; P = 0.005) as outcome predictors. In a subgroup analysis of 230 patients with Doppler data, predicted RV systolic pressure ≥40 mm Hg was associated with the primary outcome (HR 3.42; 95% CI 1.09 to 10.7; P = 0.04). Preoperative predictors of a composite secondary outcome-postoperative arrhythmias and heart failure-included older age at PVR, pre-PVR atrial tachyarrhythmias, and a higher left ventricular end-systolic volume index. Conclusions -In this observational investigation of patients with rTOF, an older age at PVR and pre-PVR RV hypertrophy and dysfunction were predictive of shorter time to postoperative death and sustained VT. These find
AU - Geva,T
AU - Mulder,B
AU - Gavreau,K
AU - Babu-Narayan,SV
AU - Wald,MD
AU - Gatzoulis,M
AU - Valente,AM
AU - Hickey,K
AU - Powell,AJ
AU - Gatzoulis,MA
DO - 10.1161/CIRCULATIONAHA.118.034740
EP - 2115
PY - 2018///
SN - 0009-7322
SP - 2106
TI - Preoperative predictors of death and sustained ventricular tachycardia after pulmonary valve replacement in patients with repaired tetralogy of fallot enrolled in the INDICATOR Cohort
T2 - Circulation
UR - http://dx.doi.org/10.1161/CIRCULATIONAHA.118.034740
UR - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.034740
UR - http://hdl.handle.net/10044/1/61604
VL - 138
ER -