Systemic right ventricular fibrosis detected by cardiovascular magnetic resonance is associated with clinical outcome, mainly new-onset atrial arrhythmia, in patients after atrial redirection surgery for transposition of the great arteries

Circ Cardiovasc Imaging. 2015 May;8(5). pii: e002628. doi: 10.1161/CIRCIMAGING.114.002628.

Systemic right ventricular fibrosis detected by cardiovascular magnetic resonance is associated with clinical outcome, mainly new-onset atrial arrhythmia, in patients after atrial redirection surgery for transposition of the great arteries.

Rydman R1Gatzoulis MA1Ho SY1Ernst S1Swan L1Li W1Wong T1Sheppard M1McCarthy KP1Roughton M1Kilner PJ1Pennell DJ1Babu-Narayan SV2.

Comment: Ventricular fibrosis is a late sequela in adult patients with a systemic right ventricle (RV) due to an atrially corrected transposition of the great arteries. In patients with acquired (left-sided) ventricular dysfunction, ventricular fibrosis has prognostic significance. Although previous cross-sectional studies suggest prognostic significance of systemic RV fibrosis as well, the current study is the first prospective study on the matter. Fifty-five patients (27+/-7 years; 50 Mustard, 5 Senning) underwent late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) to detect ventricular fibrosis, and were followed-up for 7.8 years. LGE was present in 31 (56%) of patients. Its presence was associated with increased risk of reaching composite clinical outcome (sustained tachy-arrhythmia, heart failure related admission/transplantation/death) in adult patients with a systemic RV. As LGE seems widely present in adult patients with a systemic RV, and its presence has important prognostic significance, the authors propose that LGE CMR should be incorporated into routine risk stratification in these patients.