Right ventricular (RV) late gadolinium enhancement (LGE) occurs due to surgical scarring and RV remodeling, and has been shown to be associated with clinical outcomes in Tetralogy of Fallot (TOF). However, it is not known if cardiovascular magnetic resonance (CMR) LGE extent progresses over time, and therefore, it is not known if serial reassessment of LGE is necessary. We determined the rate of progression in the extent of RV LGE on serial CMR examinations in repaired TOF. Retrospective review of 127 patients after TOF repair (49% male, median age at first CMR 18.9 years (Interquartile range (IQR) 13.3,27.0) who had at least two CMRs (median follow-up duration of 4.0 years (IQR 2.1,5.9)) was performed. 84/127 patients had no interventions between serial CMRs (Group 1) while 43/127 patients had transcatheter or surgical intervention between CMRs (Group 2). The extent of RV LGE was assessed using 2 methods: a semiquantitative RV LGE score and a quantitative RV LGE extent expressed as % of RV mass. Mixed effects linear regression modeling to estimate changes in LGE over time. RV LGE was present in all patients on the first CMR. % RV LGE extent and LGE score did not increase over time in either patient group. The mean 5 year rates of change were small and negative for both % RV LGE extent [− 2.3 (95% CI − 2.9, − 1.8, p < 0.001) in Group 1, and − 1.9 (95% CI − 3.2, − 0.7, p = 0.004) in Group 2], and RV LGE score [− 0.9 (95% CI − 1.1, − 0.6, p < 0.001) in Group 1, and − 0.5 (95% CI − 1.1, − 0.0, p = 0.047) in Group 2]. In this serial CMR evaluation of children and adults with repaired TOF, no significant progression in the extent of RV LGE was seen on intermediate term follow-up. Given recent concerns regarding the safety of gadolinium-based contrast agents, frequent assessment of LGE may not be necessary in follow-up.

中文翻译：

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法洛四联症修复后晚期钆增强程度的纵向变化：系列 CMR 的回顾性分析


右心室 (RV) 晚期钆增强 (LGE) 是由于手术疤痕和 RV 重塑而发生的，并且已被证明与法洛四联症 (TOF) 的临床结果相关。然而，尚不清楚心血管磁共振 (CMR) LGE 程度是否会随着时间的推移而进展，因此，尚不清楚是否有必要对 LGE 进行系列重新评估。我们通过一系列 CMR 检查来确定修复后 TOF 中 RV LGE 范围的进展率。对 TOF 修复后 127 名患者（49% 男性，首次 CMR 中位年龄 18.9 岁（四分位距 (IQR) 13.3,27.0））进行回顾性审查，这些患者至少有两次 CMR（中位随访时间为 4.0 年（IQR 2.1,5.9） ）））进行了连续 CMR 之间的干预（第 1 组），而 43/127 患者在 CMR 之间进行了经导管或手术干预（第 2 组）。使用 2 种方法评估 RV LGE 的程度：半定量 RV。 LGE 评分和定量 RV LGE 范围（以 RV 质量的百分比表示）用于估计 RV LGE 随时间变化的混合效应线性回归模型在第一次 CMR 时出现在所有患者中，并且 LGE 评分没有增加。随着时间的推移，任一患者组的 % RV LGE 范围的平均 5 年变化率均较小且为负值 [− 2.3 (95% CI − 2.9, − 1.8, p < 0.001)，组 1 和 − 1.9 (95)。第 2 组中 % CI − 3.2, − 0.7, p = 0.004)]，第 1 组中 RV LGE 评分 [− 0.9 (95% CI − 1.1, − 0.6, p < 0.001)，以及 − 0.5 (95% CI − 1.1, − 0.0, p = 0.047) 在第 2 组中]。在对 TOF 修复儿童和成人的系列 CMR 评估中，中期随访中未发现 RV LGE 程度显着进展。 鉴于最近对钆造影剂安全性的担忧，在随访中可能没有必要频繁评估 LGE。