Three-Dimensional Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Predicts Inducibility of Ventricular Tachycardia in Adults With Repaired Tetralogy of Fallot
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Background: Adults with repaired tetralogy of Fallot die prematurely from ventricular tachycardia (VT) and sudden cardiac death. Inducible VT predicts mortality. Ventricular scar, the key substrate for VT, can be noninvasively defined with late gadolinium enhancement (LGE) cardiovascular magnetic resonance but whether this relates to inducible VT is unknown. Methods: Sixty-nine consecutive repaired tetralogy of Fallot patients (43 male, mean 40±15 years) clinically scheduled for invasive programmed VT-stimulation were prospectively recruited for prior 3-dimensional LGE cardiovascular magnetic resonance. Ventricular LGE was segmented and merged with reconstructed cardiac chambers and LGE volume measured. Results: VT was induced in 22 (31%) patients. Univariable predictors of inducible VT included increased RV LGE (odds ratio [OR], 1.15; P =0.001 per cm 3 ), increased nonapical vent LV LGE (OR, 1.09; P =0.008 per cm 3 ), older age (OR, 1.6; P =0.01 per decile), QRS duration ≥180 ms (OR, 3.5; P =0.02), history of nonsustained VT (OR, 3.5; P =0.02), and previous clinical sustained VT (OR, 12.8; P =0.003); only prior sustained VT (OR, 8.02; P =0.02) remained independent in bivariable analyses after controlling for RV LGE volume (OR, 1.14; P =0.003). An RV LGE volume of 25 cm 3 had 72% sensitivity and 81% specificity for predicting inducible VT (area under the curve, 0.81; P <0.001). At the extreme cutoffs for ruling-out and ruling-in inducible VT, RV LGE >10 cm 3 was 100% sensitive and >36 cm 3 was 100% specific for predicting inducible VT. Conclusions: Three-dimensional LGE cardiovascular magnetic resonance-defined scar burden is independently associated with inducible VT and may help refine patient selection for programmed VT-stimulation when applied to an at least intermediate clinical risk cohort.
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LGE is present in adults with repaired TOF and is related to adverse markers of outcome such as ventricular tachycardia, exercise intolerance, and neurohormonal activation; RV LGE has been significantly associated with arrhythmia.
“LGE is present in adults with repaired TOF, and it is related to adverse markers of outcome such as ventricular tachycardia, exercise intolerance, and neurohormonal activation. RV LGE has been significantly associated with arrhythmia [51,52].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [52]
The Study Patients section reports RV LGE in all 69 adults with repaired TOF, and the Conclusions identify RV LGE scar burden as a strong predictor of inducible ventricular tachycardia. Table 1 shows a significant correlation between RV LGE volume and BNP, consistent with neurohormonal activation, but not between RV LGE volume and peak oxygen consumption, a measure of exercise capacity (P=0.3). The exercise-intolerance part is therefore not established by this paper. (LLM, conf=0.88)
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Self-citation
- Authors
- Ghonim, S., Ernst, S., Keegan, J., Giannakidis, A., Spadotto, V., Voges, I., Smith, G. C., Boutsikou, M., Montanaro, C., Wong, T., Ho, S. Y., McCarthy, K. P., Shore, D. F., Dimopoulos, K., Uebing, A., Swan, L., Li, W., Pennell, D. J., Gatzoulis, M. A., & Babu-Narayan, S. V.
- Affiliations
- Royal Brompton Hospital (GB)
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.
- ORCID
- Venue
- Circulation: Arrhythmia and Electrophysiology
- Published
- 2020-11
- Volume
- 13
- Issue
- 11
- Pages
- e008321-e008321
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W3092623943
- Cited by
- 50
- References
- 29
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 11 · 2023: 10 · 2022: 5 · 2021: 10 · 2020: 1
- FWCI
- 4.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Nottingham Trent University's Institutional Repository (Nottingham Trent Repository) (acceptedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- British Heart Foundation (FS/11/38/28864)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- repaired tetralogy of Fallot, ventricular tachycardia, late gadolinium enhancement, ventricular scar, sudden cardiac death, QRS duration, non-sustained ventricular tachycardia, risk stratification, adult congenital heart disease
- MeSH terms
- Adult, Contrast Media, Female, Gadolinium, Cardiac Surgical Procedures, Heart Ventricles, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Myocardium, Predictive Value of Tests, Prospective Studies, Risk Factors, Tetralogy of Fallot, Treatment Outcome, Tachycardia, Ventricular, Imaging, Three-Dimensional, Electrophysiologic Techniques, Cardiac
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