Author + information
- Teun van der Bom,
- Michiel Winter,
- Maarten Groenink,
- Hubert Vliegen,
- Petronella Pieper,
- Arie van Dijk,
- Gertjan Sieswerda,
- Jolien Roos-Hesselink,
- Aeilko Zwinderman,
- Barbara Mulder and
- Berto Bouma
In patients with a congenitally corrected transposition of the great arteries or atrially corrected transposition of the great arteries, the systemic right ventricle worsen slowly over time. Worsening is often accompanied by clinical events, such as clinical heart-failure or the development of arrhythmia. However, there are large differences in the occurrence and onset of these events. We aimed to identify which patients are most likely to experience clinical events.
At baseline, all participants of the valsartan trial underwent regular electrocardiography, 24-hour ambulatory electrocardiography, echocardiography, cardiopulmonary exercise testing, and cardiovascular magnetic resonance imaging or multi-row detector computed tomography in those with pacemakers. Clinical events comprised death, tricuspid regurgitation requiring invasive treatment, ventricular and supraventricular arrhythmia, and worsening heart failure. A Cox proportional hazards analysis was used to assess determinants of event-free survival.
A total of 88 patients with a mean age of 33 years, 65% men and 28% ccTGA were included. During a median of 4.3 years 31 patients (35%) experienced 50 clinical events; an annual risk of 13%. Peak exercise systolic blood pressure (HR 0.86, p=0.02) and right ventricular end-diastolic volume measured by means of CMR (HR 1.20, p<0.0001) were the strongest determinants of clinical events. The combination of these determinants resulted in a negative predictive value for clinical events during 4 years of 96%. These determinants (ROC 0.88) were superior to echo-and electrocardiographic predictors (ROC 0.70).
Patients with a systemic right ventricle have a high annual risk of clinical events. Patients with a peak exercise systolic blood pressure above 180mmHg and patients with only moderately dilated right ventricles had a very low risk of clinical events and might be considered for biannual clinical follow-up, whereas current guidelines recommend annual follow-up.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: Pot Pourri
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 1248-131
- 2013 American College of Cardiology Foundation