RESUMEN
BACKGROUND: Impaired right ventricular (RV) mechanics is a common problem in patients after repair of tetralogy of Fallot (TOF). Moreover, also impaired left ventricular (LV) systolic function has been demonstrated in this population. There are no studies evaluating patients after TOF repair with impaired both RV and LV ejection fractions (RVEF, LVEF). AIM: We hypothesized that a considerable group of patients with repaired TOF would demonstrate both RV and LV systolic function impairment. Accordingly, the purpose of our study was to characterize patients with biventricular dysfunction after TOF repair. METHODS: Consecutive patients with repaired TOF undergoing cardiac magnetic resonance (n=146, mean age 26.4±8.2 years, age range: 13.6-51.3 years, 60.3% males, 54 patients [37.0%] with early correction and 92 [63.0%] with late correction). RESULTS: There were 31 patients (21.2% of the study population; 90.3% males) with biventricular dysfunction. Normal both RVEF and LVEF were observed in 65 individuals (44.5%). Neither the presence nor the extent of late gadolinium enhancement differed between patients with normal both RVEF and LVEF vs low both RVEF and LVEF. There were no differences in pulmonary regurgitation (PR) fraction, peak right ventricular outflow tract (RVOT) gradient, and the incidences of significant PR and RVOT obstruction between these groups (P=NS for all comparisons). Multivariate logistic regression revealed that the male sex and RVOT aneurysm/akinesia (only in patients repaired early) were associated with the presence of biventricular dysfunction. CONCLUSIONS: In patients with repaired TOF, : Male sex and RVOT aneurysm/akinesia were independently associated with biventricular dysfunction. Impaired both RVEF and LVEF were common in patients with repaired TOF, with the vast majority of males.
RESUMEN
We investigated B-type natriuretic peptide (BNP) levels in 10 consecutive patients (all women, mean age 60.4+/-7.8 years) with apical ballooning syndrome. Mean baseline plasma BNP level was 272.6+/-170.4 pg/ml and exceeded the normal range in 8 (80%) patients. When normal levels were adjusted for age and gender, all 10 patients had elevated BNP. Two patients with the highest BNP levels (630 and 423 pg/ml) presented with significant hemodynamic compromise. BNP levels correlated negatively with left ventricular ejection fraction. Increase in BNP levels in apical ballooning syndrome may support the neurohormonal etiology in these patients and requires further studies.