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Right ventricular myocardial fibrosis evaluated by extracellular volume fraction by magnetic resonance imaging in patients with repaired tetralogy of Fallot: a meta-analysis

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Abstract

Objective

The objective of this meta-analysis was to assess the clinical utility of anomalous discoveries on cardiac magnetic resonance, particularly the right ventricular extracellular volume (RV-ECV), among individuals who underwent surgical repair for Tetralogy of Fallot (rTOF).

Methods

We conducted a systematic search of electronic databases including PubMed, Web of Science Core Collection, Cochrane advanced search, and EMBASE. Our analysis involved a comparison of ECV levels between rTOF patients and controls, as well as an evaluation of the predictive value of ECV for future adverse events.

Results

We identified 16 eligible studies that encompassed 856 rTOF patients and 283 controls. Our meta-analysis showed a significant increase in LV-ECV among rTOF patients compared to control subjects (MD = 2.63, 95%CI: 1.35 to 3.90, p < 0.0001, I2 = 86%, p for heterogeneity < 0.00001). Moreover, RV-ECV was found to be substantially higher in patients compared to LV-ECV. Our meta-analysis also revealed a significant association between RV-ECV and adverse events (HR = 1.15, 95% CI: 1.04 to 1.27, p = 0.005, I2 = 0%, p for heterogeneity = 0.62), while LV-ECV did not show any significant association with adverse events (HR = 1.12, 95% CI: 0.92 to 1.36, p = 0.16, I2 = 0%, p for heterogeneity = 0.46).

Conclusion

The results of this meta-analysis on RV-ECV confirmed the presence of RV fibrosis as one of the prognostic factors in rTOF patients.

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Abbreviations

CI:

Confidence interval

CMR:

Cardiac magnetic resonance

ECV:

Extracellular volume fraction

LGE:

Late gadolinium enhancement

LV:

Left ventricular

MD:

Mean difference

MRI:

Magnetic resonance imaging

rTOF:

Repaired tetralogy of Fallot

RV:

Right ventricular

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Acknowledgements

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Funding

Research Grant, Japan Society for the Promotion of Science: Grant-in-Aid for Young Scientists.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Toshiki Tanigaki, Shingo Kato & Daisuke Utsunomiya

  2. Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan

    Mai Azuma

  3. Department of Cardiology, Yokohama City University, Yokohama, Japan

    Manabu Nitta

  4. Chemotherapy Center, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Nobuyuki Horita

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  1. Toshiki Tanigaki
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Correspondence to Shingo Kato.

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Tanigaki, T., Kato, S., Azuma, M. et al. Right ventricular myocardial fibrosis evaluated by extracellular volume fraction by magnetic resonance imaging in patients with repaired tetralogy of Fallot: a meta-analysis. Heart Vessels 39, 349–358 (2024). https://doi.org/10.1007/s00380-023-02332-y

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