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Published on: May 13, 2019
Heart failure and ventricular dysfunction in patients with single or systemic right ventricles
Sanaz Piran1, Gruschen Veldtman, Samuel Siu
1Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network, University of Toronto, University of Toronto, Canada.
Circulation
|March 13, 2002
Summary
Adults with single or systemic right ventricles face a high risk of heart failure and mortality. Early identification and intervention are crucial for preserving ventricular function and improving outcomes.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Adult Congenital Heart Disease
Background:
- Previous studies indicated high congestive heart failure rates in single/systemic right ventricle patients.
- The risk in the adult population remained largely unknown.
Purpose of the Study:
- To assess the risk of heart failure in adult patients with single or systemic right ventricles.
- To identify predictors of heart failure and mortality in this population.
Main Methods:
- Prospective assessment of 188 adult patients with single or systemic right ventricles.
- Utilized gated radionuclide angiography and 2D echocardiography for ventricular assessment.
- Clinical follow-up included New York Heart Association (NYHA) classification and mortality tracking.
Main Results:
- Heart failure incidence varied by surgical history: 22.2% (transposition of great arteries with Mustard procedure), 32.3% (congenitally corrected transposition), 40% (Fontan-palliated).
- Symptomatic patients exhibited significantly lower anaerobic thresholds and peak oxygen consumption (VO2).
- Systemic ventricular ejection fraction was markedly reduced in symptomatic versus asymptomatic patients (34.8% vs. 46.7%).
- Mortality was substantially higher in symptomatic patients (47.1%) compared to asymptomatic patients (5%) over 15.7 years.
- NYHA class, systemic ejection fraction, and age at operation were key predictors of mortality.
Conclusions:
- Patients with single or systemic right ventricles face a significant risk of heart failure and associated high mortality.
- Identifying at-risk individuals is crucial for implementing strategies to preserve ventricular function.
- Proactive management is essential for improving long-term outcomes in this vulnerable patient group.
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