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. 2021 Jun 21;23(1):80.
doi: 10.1186/s12968-021-00772-x.

Longitudinal changes in extent of late gadolinium enhancement in repaired Tetralogy of Fallot: a retrospective analysis of serial CMRs

Kwannapas Saengsin  1 , Minmin Lu  1 , Lynn Sleeper  1   2 , Tal Geva  1   2 , Ashwin Prakash  3   4
Affiliations

Longitudinal changes in extent of late gadolinium enhancement in repaired Tetralogy of Fallot: a retrospective analysis of serial CMRs

Kwannapas Saengsin et al. J Cardiovasc Magn Reson. .

Abstract

Background: Right ventricular (RV) late gadolinium enhancement (LGE) occurs due to surgical scarring and RV remodeling, and has been shown to be associated with clinical outcomes in Tetralogy of Fallot (TOF). However, it is not known if cardiovascular magnetic resonance (CMR) LGE extent progresses over time, and therefore, it is not known if serial reassessment of LGE is necessary. We determined the rate of progression in the extent of RV LGE on serial CMR examinations in repaired TOF.

Methods: Retrospective review of 127 patients after TOF repair (49% male, median age at first CMR 18.9 years (Interquartile range (IQR) 13.3,27.0) who had at least two CMRs (median follow-up duration of 4.0 years (IQR 2.1,5.9)) was performed. 84/127 patients had no interventions between serial CMRs (Group 1) while 43/127 patients had transcatheter or surgical intervention between CMRs (Group 2). The extent of RV LGE was assessed using 2 methods: a semiquantitative RV LGE score and a quantitative RV LGE extent expressed as % of RV mass. Mixed effects linear regression modeling to estimate changes in LGE over time.

Results: RV LGE was present in all patients on the first CMR. % RV LGE extent and LGE score did not increase over time in either patient group. The mean 5 year rates of change were small and negative for both % RV LGE extent [- 2.3 (95% CI - 2.9, - 1.8, p < 0.001) in Group 1, and - 1.9 (95% CI - 3.2, - 0.7, p = 0.004) in Group 2], and RV LGE score [- 0.9 (95% CI - 1.1, - 0.6, p < 0.001) in Group 1, and - 0.5 (95% CI - 1.1, - 0.0, p = 0.047) in Group 2].

Conclusions: In this serial CMR evaluation of children and adults with repaired TOF, no significant progression in the extent of RV LGE was seen on intermediate term follow-up. Given recent concerns regarding the safety of gadolinium-based contrast agents, frequent assessment of LGE may not be necessary in follow-up.

Keywords: Cardiovascular magnetic resonance; Late gadolinium enhancement; Longitudinal study; Tetralogy of Fallot.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
RV LGE Assessment. a RV LGE score: RV divided into 9 segments. Each segment graded as follows: 0—no LGE; 1—LGE involving < 1/3 of segment; 2—LGE involving 1/3—2/3 of segment; 3—LGE involving > 2/3 of segment (maximum possible score 27) b Example of cine ventricular short axis in diastolic phase c Example of LGE imaging in the ventricular short axis. d % RV LGE Extent: Areas of LGE highlighted using semi- automated manual thresholding. % RV LGE Extent = (RV LGE mass/ Total RV mass) × 100
Fig. 2
Fig. 2
Longitudinal Changes in RV LGE Score and % RV LGE Extent. Group 1—patients with no interventions between serial CMRs; Group 2—patients with transcatheter or surgical interventions between CMRs. The thick blue line represents the estimated slope of change over time determined using linear mixed-effects modeling
Fig. 3
Fig. 3
Longitudinal Changes in Segmental RV LGE Score. Group 1—patients with no interventions between serial CMRs; Group 2—patients with transcatheter or surgical interventions between CMRs. Median baseline and follow-up RV LGE scores for each segment are annotated next to each segment
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