Impact of Gender and Age on Cardiovascular Function Late After Repair of Tetralogy of Fallot: Percentiles Based on Cardiac Magnetic Resonance
Background—The impact of gender and age on cardiac function by cardiac magnetic resonance (CMR) in repaired tetralogy of Fallot (TOF) is unknown, which limits the value of currently discussed volumetric thresholds and the accuracy of individual follow-up.
Methods and Results—In a nationwide prospective 14-center study, 407 consecutive patients with repaired TOF (age 17.9±8.3 years, range 8-59 years, 226 males) underwent standardized CMR ventricular volumetry and flow quantification (pulmonary artery/ascending aorta). There were no sex differences for age at TOF repair, type of repair, number of pre-repair palliations or re-interventions after repair, pulmonary regurgitation fraction and maximal gradient across the right ventricular outflow tract. Biventricular volumes and mass (indexed to body surface area), available in n=380/407, were higher in males (p<0.003) but biventricular ejection fraction higher in females (p<0.012). As opposed to reported data of healthy populations, sex-specific reference percentiles computed for an age range of 8-40 years (Lambda-Mu-Sigma method) demonstrated (1) increase of enddiastolic/endsystolic left ventricular volumes, particularly in females; (2) increase of endsystolic RV volumes in both sexes; (3) decrease of biventricular ejection fraction in males whilst in females only right ventricular ejection fraction decreased.
Conclusions—Significant gender differences of biventricular volumes, function and mass by CMR exist late after repair of TOF suggesting that age and gender cannot be ignored when discussing thresholds. Gender-specific percentiles may present a more relevant framework of reference for an individual patient at a given age, and suggest a gradual decline of biventricular systolic function over time.
Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00266188.
- Received February 7, 2011.
- Accepted July 31, 2011.
- Copyright © 2011, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited