Appearance of QRS fragmentation late after Mustard/Senning repair is associated with adverse outcome

Helsen, Frederik; Vandenberk, Bert; Meester, Pieter De; Bruaene, Alexander Van De; Gabriels, Charlien; Troost, Els; Gewillig, Marc; Meyns, Bart; Willems, Rik; Budts, Werner

doi:10.1136/heartjnl-2016-310512

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…This is in contrast to the rather subtle changes in deformation imaging observed over a 15-year time period, with reductions in peak systolic strain rate and strain only observed in the apical segment of the RV free wall. Tricuspid valve regurgitation has been described as a marker of outcome 16 as well as a reflection of sRV dysfunction. Unfortunately, since peak systolic strain and strain rate are load dependent 14,17 , the increase in tricuspid valve regurgitation may mask a more significant reduction in parameters reflecting systolic function of the sRV 14 .…”

Section: Discussionmentioning

confidence: 99%

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15-Year follow-up of regional right and left ventricular function after the Senning operation: a Colour-Doppler myocardial imaging study

Moyá

Meester²,

Troost³

et al. 2020

Acta Cardiologica

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Introduction: Despite right ventricular (RV) dysfunction being a major concern in Senning patients, long-term follow-up data is lacking. This study aimed (1) at evaluating regional (base-mid-apex) RV and left ventricular (LV) function using Colour-Doppler myocardial imaging over a 15-year follow-up period and (2) at comparing results with matched controls.Methods: For the longitudinal analysis (2004→2019), we compared systolic and diastolic function in 10 Senning patients. For the cross-sectional analysis, we compared the subaortic RV (sRV) of Senning patients with the RV and LV of matched controls and the subpulmonary LV (spLV) of Senning patients with the LV of matched controls. Results:The longitudinal analysis of sRV function showed a significant decrease in apical peak systolic strain (-17±7% vs -12±4%; P=0.025) and apical peak systolic strain rate (-1.1±0.3s -1 vs -0.8±0.4s -1; P=0.012). spLV function showed a significant decrease in peak systolic velocity (mid; P=0.013 and apex; P=0.011) and peak systolic strain rate (mid;P=0.048). The cross-sectional analysis revealed significant lower values for basal, mid and apical peak systolic velocity, peak systolic strain rate, peak systolic strain of the sRV of Senning patients when compared to both LV and RV of matched controls (all P<0.05). Conclusion:Our study showed that systolic and diastolic sRV function did not change over a 15-year follow-up period, except in the apical region. There was a decline in spLV systolic function, which may be of clinical value. On the other hand, when compared to age-and gender-matched controls, the sRV of Senning patients exhibits significantly decreased measurements of longitudinal systolic function.

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Section: Discussionmentioning

confidence: 99%

“…It could also be that once sRV dysfunction occurs, patients rather quickly develop overt clinical heart failure 7 . Progressive fibrosis has been reported 23 and could significantly impact diastolic function 8,16 . Although we observed a numerical reduction in peak early diastolic velocities, this did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

15-Year follow-up of regional right and left ventricular function after the Senning operation: a Colour-Doppler myocardial imaging study

Moyá

Meester²,

Troost³

et al. 2020

Acta Cardiologica

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“…Fragmented QRS on 12-lead ECG has been associated with adverse outcome, ventricular arrhythmia and sudden cardiac death. These fQRS related complications are not only found in ischemic cardiomyopathy (50) but also in adults with TOF (51), after atrial switch repair for d-TGA (49), and in adults with Ebstein anomaly and larger atrialized RV area (52). In addition, the extent of fQRS was documented to be superior to QRS duration in predicting all-cause mortality.…”

Section: Electrocardiogram (Ecg)mentioning

confidence: 97%

“…More recently, there has been an emerging interest in QRS fragmentation. Fragmented QRS-complexes (fQRS) are caused by activation paths inside ventricular scars that are prone to re-entry circuits, hence a marker of inhomogeneous ventricular activation due to myocardial fibrosis (49). In ACHD patients, fibrosis and scar tissue occur, more often the result of surgery.…”

Section: Electrocardiogram (Ecg)mentioning

confidence: 99%

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Diagnosis and treatment of right ventricular dysfunction in congenital heart disease

Santens¹,

Bruaene²,

Meester³

et al. 2020

Cardiovasc Diagn Ther

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Right ventricular (RV) function is important for clinical status and outcomes in children and adults with congenital heart disease (CHD). In the normal RV, longitudinal systolic function is the major contributor to global RV systolic function. A variety of factors contribute to RV failure including increased pressure-or volume-loading, electromechanical dyssynchrony, increased myocardial fibrosis, abnormal coronary perfusion, restricted filling capacity and adverse interactions between left ventricle (LV) and RV.We discuss the different imaging techniques both at rest and during exercise to define and detect RV failure.We identify the most important biomarkers for risk stratification in RV dysfunction, including abnormal NYHA class, decreased exercise capacity, low blood pressure, and increased levels of NTproBNP, troponin T, galectin-3 and growth differentiation factor 15. In adults with CHD (ACHD), fragmented QRS is independently associated with heart failure (HF) symptoms and impaired ventricular function. Furthermore, we discuss the different HF therapies in CHD but given the broad clinical spectrum of CHD, it is important to treat RV failure in a disease-specific manner and based on the specific alterations in hemodynamics. Here, we discuss how to detect and treat RV dysfunction in CHD in order to prevent or postpone RV failure.

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Adult Congenital Heart Disease

Drakopoulou

Dimopoulos

Prapa

et al. 2023

Pediatric Cardiac Surgery

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Appearance of QRS fragmentation late after Mustard/Senning repair is associated with adverse outcome

Abstract: Appearance of fQRS complexes on a 12-lead ECG is associated with adverse outcome in adults after atrial switch repair for d-TGA. In this population, fQRS detection might be a promising and easily implementable tool to identify patients at risk for adverse events.

Cited by 15 publications

References 30 publications

15-Year follow-up of regional right and left ventricular function after the Senning operation: a Colour-Doppler myocardial imaging study

15-Year follow-up of regional right and left ventricular function after the Senning operation: a Colour-Doppler myocardial imaging study

Diagnosis and treatment of right ventricular dysfunction in congenital heart disease

Adult Congenital Heart Disease

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