Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement

Kenichiro Yamamura, Darren Yuen, Edward J. Hickey, Xiaolin He, Rajiv R. Chaturvedi, Mark K. Friedberg, Lars Grosse-Wortmann, Kate Hanneman, Filio Billia, Michael E. Farkouh, Rachel M. Wald

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective The relationship between right ventricular (RV) fibrosis and right heart reverse remodelling following pulmonary valve replacement (PVR) has not been well studied in adults with repaired tetralogy of Fallot (rTOF). Our aims were to histologically quantify RV fibrosis and to explore the relationship between fibrosis severity and cardiac remodelling post-PVR. Methods Adults with rTOF and pre-PVR cardiovascular (CMR) imaging were consented to procurement of RV muscle during PVR. Samples were stained with picrosirius red to quantify collagen volume fraction. Clinical data at baseline and at last follow-up were reviewed. Adverse cardiovascular outcomes included death, sustained arrhythmia and heart failure. Results Fifty-three patients (male 58%, 38±11 years) were studied. Those with severe fibrosis (collagen volume fraction >11.0%, n=13) had longer aortic cross-clamp times at initial repair compared with the remainder of the population (50 vs 33 min, p=0.018) and increased RV mass:volume ratio pre-PVR (0.20 vs 0.18 g/mL, p=0.028). Post-PVR, the severe fibrosis group had increased indexed RV end-systolic volume index (RVESVi) (74 vs 66 mL/m 2, p=0.044), decreased RVESVi change (I "29 vs I "45 mL/m 2, p=0.005), increased RV mass (34 vs 25 g/m 2, p=0.023) and larger right atrial (RA) area (21 vs 17 cm 2, p=0.021). A trend towards increased heart failure events was observed in the severe fibrosis group (15% vs 0%, p=0.057). Conclusions Severe RV fibrosis was associated with increased RVESVi, RV mass and RA area post-PVR in rTOF. Further study is required to define the impact of fibrosis and persistent right heart enlargement on clinical outcomes.

Original languageEnglish
Pages (from-to)855-863
Number of pages9
JournalHeart
Volume105
Issue number11
DOIs
Publication statusPublished - Jun 1 2019
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement'. Together they form a unique fingerprint.

  • Cite this

    Yamamura, K., Yuen, D., Hickey, E. J., He, X., Chaturvedi, R. R., Friedberg, M. K., Grosse-Wortmann, L., Hanneman, K., Billia, F., Farkouh, M. E., & Wald, R. M. (2019). Right ventricular fibrosis is associated with cardiac remodelling after pulmonary valve replacement. Heart, 105(11), 855-863. https://doi.org/10.1136/heartjnl-2018-313961