Author + information
- Matthew J. Lewisa,b,
- Michiel Wintera,b,
- Alexandra Van Dissela,b,
- Jonathan Ginnsa,b,
- Noa Zemer-Wassercuga,b,
- Barbara Muldera,b and
- Marlon Rosenbauma,b
Background: Adult patients with congenitally corrected transposition of the great arteries (ccTGA) and D-transposition of the arteries (D-TGA) after a Mustard or Senning repair develop systemic right ventricular (SRV) dilation. However, the time frame and risk factors for progressive SRV enlargement remain unclear. We assessed the hypothesis that progressive SRV enlargement would be present and associated with patient specific factors over serial cardiac MRIs (CMR).
Methods: A retrospective study of all patients age>18 years with a SRV who underwent serial CMRs at Columbia University Medical Center and the University of Amsterdam Academic Medical Center was performed. Ventricular size and function was assessed by CMR. Clinical and echocardiographic variables were also assessed.
Results: 105 patients (65% male), with a mean age of 32 ± 9 years met inclusion criteria. 29 (28%) had ccTGA and 76 (72%) had undergone a Mustard or Senning repair. 28 (27%) were on an ACE-inhibitor, 21 (20%) were on a beta-blocker, and 23 (22%) were obese. Mean time between CMRs was 3.5 ± 1.6 years. Mean right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) were significantly different between the first and second CMR (243 ml vs. 255 ml, p=0.0002 and 142 ml vs. 162 ml, p<0.0001). There was no significant change in right ventricular ejection fraction. In a multivariable regression model of change in RVEDV that included follow-up duration, obesity, ≥ moderate tricuspid regurgitation (TR), gender and diagnosis, only follow-up duration (β=6.2, p=0.002) and obesity (β=14.8, p=0.047) were significant. In the same model with change in RVESV as the outcome, follow-up duration (β=5.9, p=0.046) and obesity (β=23.2 p=0.043) remained the only significant covariates. Ace-inhibitor and beta-blocker use were not significantly associated with either change in RVEDV or RVESV.
Conclusions: In our multicenter cohort of patients with D-TGA and ccTGA, progressive SRV enlargement was observed by CMR. Obesity, but not TR, was associated with a greater degree of SRV dilation over the study period. These results may have implications on how patients with a SRV are followed.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 10:15 a.m.-10:25 a.m.
Session Title: Congenital Heart Disease: To the Third Decade and Beyond
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1131M-05
- 2017 American College of Cardiology Foundation