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QUALITY OF LIFE IN PATIENTS WITH TETRALOGY OF FALLOT AFTER PULMONARY VALVE REPLACEMENT: IS THERE AN ASSOCIATION WITH IMPROVEMENT IN RIGHT VENTRICULAR SIZE BY CARDIAC MRI?
966 JACC April 5, 2016 Volume 67, Issue 13
Congenital Heart Disease QUALITY OF LIFE IN PATIENTS WITH TETRALOGY OF FALLOT AFTER PULMONARY VALVE REPLACEMENT: IS THERE AN ASSOCIATION WITH IMPROVEMENT IN RIGHT VENTRICULAR SIZE BY CARDIAC MRI? Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m. Session Title: A Time to Reflect: Novel Insights From Congenital Heart Disease Surgical Follow Up Abstract Category: 22. Congenital Heart Disease: Adult Presentation Number: 1178-192 Authors: Matthew J. Lewis, Harsimran Singh, Jonathan Ginns, Marlon Rosenbaum, Columbia University Medical Center, New York, NY, USA
Background: There is increasing reliance on cardiac MRI derived volumetric thresholds to determine timing of pulmonary valve replacement (PVR) in tetralogy of Fallot (TOF). However, there is minimal evidence correlating reduced right ventricular size with exercise capacity and quality of life (QOL). The RAND-36 survey is the gold standard for QOL assessment. We sought to determine if post-PVR changes in right ventricular volume correlated with improvements in patient QOL.
Methods: The RAND-36 item QOL survey was administered to patients with TOF before and after PVR. Scores were calculated according to instrument protocol. Pre and post PVR right ventricular end-diastolic volume (RVEDVI), right ventricular end-systolic volume (RVESVI), and right ventricular ejection fraction were calculated for each patient. QOL scores and MRI metrics were categorized according to degree of improvement. Results: 27 (36% female, mean age at PVR: 32years) patients completed the RAND survey and had a MRI before and after PVR. There was a significant improvement in QOL across all tested domains following PVR. There was a significant decrease in mean RVEDVI (179 ml/m2 vs. 120 ml/m2 , p<0.001) and mean RVESVI (103 ml/m2 vs. 68 ml/m2 , p<0.001) but no significant change in right ventricular ejection fraction (43% vs. 44%, p=0.63). 19 (70%) patients had a >25% reduction in RVEDVI. Reduction in RVEDVI >25% was associated with a greater increase in energy and decrease in fatigue compared to patients with <25% decrease in RVEDVI (p=0.026). There was no significant association between change in RVEDVI and either improvement in physical functioning or reduction physical health limitations. There was also no significant difference in any QOL improvement domain by pre-PVR RVEDVI, RVESVI, or right ventricular ejection fraction.
Conclusions: While a greater degree of improvement in energy was observed in patients who achieved >25% reduction in RVEDVI following PVR, the majority of QOL indices were not correlated with changes in RV size. Despite increased enthusiasm for PVR, surrogate measures of patient outcomes are only weakly associated with improvements in right ventricular size.
Congenital Heart Disease QUALITY OF LIFE IN PATIENTS WITH TETRALOGY OF FALLOT AFTER PULMONARY VALVE REPLACEMENT: IS THERE AN ASSOCIATION WITH IMPROVEMENT IN RIGHT VENTRICULAR SIZE BY CARDIAC MRI? Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m. Session Title: A Time to Reflect: Novel Insights From Congenital Heart Disease Surgical Follow Up Abstract Category: 22. Congenital Heart Disease: Adult Presentation Number: 1178-192 Authors: Matthew J. Lewis, Harsimran Singh, Jonathan Ginns, Marlon Rosenbaum, Columbia University Medical Center, New York, NY, USA
Background: There is increasing reliance on cardiac MRI derived volumetric thresholds to determine timing of pulmonary valve replacement (PVR) in tetralogy of Fallot (TOF). However, there is minimal evidence correlating reduced right ventricular size with exercise capacity and quality of life (QOL). The RAND-36 survey is the gold standard for QOL assessment. We sought to determine if post-PVR changes in right ventricular volume correlated with improvements in patient QOL.
Methods: The RAND-36 item QOL survey was administered to patients with TOF before and after PVR. Scores were calculated according to instrument protocol. Pre and post PVR right ventricular end-diastolic volume (RVEDVI), right ventricular end-systolic volume (RVESVI), and right ventricular ejection fraction were calculated for each patient. QOL scores and MRI metrics were categorized according to degree of improvement. Results: 27 (36% female, mean age at PVR: 32years) patients completed the RAND survey and had a MRI before and after PVR. There was a significant improvement in QOL across all tested domains following PVR. There was a significant decrease in mean RVEDVI (179 ml/m2 vs. 120 ml/m2 , p<0.001) and mean RVESVI (103 ml/m2 vs. 68 ml/m2 , p<0.001) but no significant change in right ventricular ejection fraction (43% vs. 44%, p=0.63). 19 (70%) patients had a >25% reduction in RVEDVI. Reduction in RVEDVI >25% was associated with a greater increase in energy and decrease in fatigue compared to patients with <25% decrease in RVEDVI (p=0.026). There was no significant association between change in RVEDVI and either improvement in physical functioning or reduction physical health limitations. There was also no significant difference in any QOL improvement domain by pre-PVR RVEDVI, RVESVI, or right ventricular ejection fraction.
Conclusions: While a greater degree of improvement in energy was observed in patients who achieved >25% reduction in RVEDVI following PVR, the majority of QOL indices were not correlated with changes in RV size. Despite increased enthusiasm for PVR, surrogate measures of patient outcomes are only weakly associated with improvements in right ventricular size.