Left Ventricular Systolic Dysfunction and Cardiovascular Outcomes in Tetralogy of Fallot: Systematic Review and Meta-analysis

Alexander C. Egbe, Rosalyn Adigun, Vidhu Anand, Collin P. West, Victor M. Montori, Hassan M. Murad, Emmanuel Akintoye, Karim Osman, Heidi M. Connolly

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background: Although there are robust data about the pathophysiology and prognostic implications of left ventricular (LV) systolic dysfunction in patients with acquired heart disease, similar prognostic data about LV systolic dysfunction are sparse in the tetralogy of Fallot (TOF) population. The purpose of this study was to perform a meta-analysis of all studies that assessed the relationship between LV ejection fraction (LVEF) and cardiovascular adverse events (CAEs) defined as death, aborted sudden death, or sustained ventricular tachycardia. Methods: We used random-effects models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Of the 1,809 citations, 7 studies with 2,854 patients (age 28 ± 4 years) were included. During 5.6 ± 3.4 years' follow-up, there were 82 deaths, 17 aborted sudden cardiac deaths, and 56 sustained ventricular tachycardia events. Overall, CAEs occurred in 5.1% (144 patients). As a continuous variable, LVEF was a predictor of CAE (HR 1.29, 95% CI, 1.09-1.53, P = 0.001) per 5% decrease in LVEF. Similarly, LVEF < 40% was also a predictor of CAE (HR 3.22, 95% CI, 2.16-4.80, P < 0.001). Conclusions: LV systolic dysfunction was an independent predictor of CAE, and we observed a 30% increase in the risk of CAE for every 5% decrease in LVEF, and a 3-fold increase in the risk of CAE in patients with LVEF <40% compared with other patients. These findings underscore the importance of incorporating LV systolic function in clinical risk stratification of patients with TOF and the need to explore new treatment options to address this problem.

Original languageEnglish (US)
JournalCanadian Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2019

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Tetralogy of Fallot
Left Ventricular Dysfunction
Meta-Analysis
Confidence Intervals
Ventricular Tachycardia
Sudden Cardiac Death
Sudden Death
Left Ventricular Function
Stroke Volume
Heart Diseases
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Left Ventricular Systolic Dysfunction and Cardiovascular Outcomes in Tetralogy of Fallot : Systematic Review and Meta-analysis. / Egbe, Alexander C.; Adigun, Rosalyn; Anand, Vidhu; West, Collin P.; Montori, Victor M.; Murad, Hassan M.; Akintoye, Emmanuel; Osman, Karim; Connolly, Heidi M.

In: Canadian Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalReview article

Egbe, Alexander C. ; Adigun, Rosalyn ; Anand, Vidhu ; West, Collin P. ; Montori, Victor M. ; Murad, Hassan M. ; Akintoye, Emmanuel ; Osman, Karim ; Connolly, Heidi M. / Left Ventricular Systolic Dysfunction and Cardiovascular Outcomes in Tetralogy of Fallot : Systematic Review and Meta-analysis. In: Canadian Journal of Cardiology. 2019.
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title = "Left Ventricular Systolic Dysfunction and Cardiovascular Outcomes in Tetralogy of Fallot: Systematic Review and Meta-analysis",
abstract = "Background: Although there are robust data about the pathophysiology and prognostic implications of left ventricular (LV) systolic dysfunction in patients with acquired heart disease, similar prognostic data about LV systolic dysfunction are sparse in the tetralogy of Fallot (TOF) population. The purpose of this study was to perform a meta-analysis of all studies that assessed the relationship between LV ejection fraction (LVEF) and cardiovascular adverse events (CAEs) defined as death, aborted sudden death, or sustained ventricular tachycardia. Methods: We used random-effects models to calculate hazard ratios (HRs) and 95{\%} confidence intervals (CIs). Results: Of the 1,809 citations, 7 studies with 2,854 patients (age 28 ± 4 years) were included. During 5.6 ± 3.4 years' follow-up, there were 82 deaths, 17 aborted sudden cardiac deaths, and 56 sustained ventricular tachycardia events. Overall, CAEs occurred in 5.1{\%} (144 patients). As a continuous variable, LVEF was a predictor of CAE (HR 1.29, 95{\%} CI, 1.09-1.53, P = 0.001) per 5{\%} decrease in LVEF. Similarly, LVEF < 40{\%} was also a predictor of CAE (HR 3.22, 95{\%} CI, 2.16-4.80, P < 0.001). Conclusions: LV systolic dysfunction was an independent predictor of CAE, and we observed a 30{\%} increase in the risk of CAE for every 5{\%} decrease in LVEF, and a 3-fold increase in the risk of CAE in patients with LVEF <40{\%} compared with other patients. These findings underscore the importance of incorporating LV systolic function in clinical risk stratification of patients with TOF and the need to explore new treatment options to address this problem.",
author = "Egbe, {Alexander C.} and Rosalyn Adigun and Vidhu Anand and West, {Collin P.} and Montori, {Victor M.} and Murad, {Hassan M.} and Emmanuel Akintoye and Karim Osman and Connolly, {Heidi M.}",
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T1 - Left Ventricular Systolic Dysfunction and Cardiovascular Outcomes in Tetralogy of Fallot

T2 - Systematic Review and Meta-analysis

AU - Egbe, Alexander C.

AU - Adigun, Rosalyn

AU - Anand, Vidhu

AU - West, Collin P.

AU - Montori, Victor M.

AU - Murad, Hassan M.

AU - Akintoye, Emmanuel

AU - Osman, Karim

AU - Connolly, Heidi M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Although there are robust data about the pathophysiology and prognostic implications of left ventricular (LV) systolic dysfunction in patients with acquired heart disease, similar prognostic data about LV systolic dysfunction are sparse in the tetralogy of Fallot (TOF) population. The purpose of this study was to perform a meta-analysis of all studies that assessed the relationship between LV ejection fraction (LVEF) and cardiovascular adverse events (CAEs) defined as death, aborted sudden death, or sustained ventricular tachycardia. Methods: We used random-effects models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Of the 1,809 citations, 7 studies with 2,854 patients (age 28 ± 4 years) were included. During 5.6 ± 3.4 years' follow-up, there were 82 deaths, 17 aborted sudden cardiac deaths, and 56 sustained ventricular tachycardia events. Overall, CAEs occurred in 5.1% (144 patients). As a continuous variable, LVEF was a predictor of CAE (HR 1.29, 95% CI, 1.09-1.53, P = 0.001) per 5% decrease in LVEF. Similarly, LVEF < 40% was also a predictor of CAE (HR 3.22, 95% CI, 2.16-4.80, P < 0.001). Conclusions: LV systolic dysfunction was an independent predictor of CAE, and we observed a 30% increase in the risk of CAE for every 5% decrease in LVEF, and a 3-fold increase in the risk of CAE in patients with LVEF <40% compared with other patients. These findings underscore the importance of incorporating LV systolic function in clinical risk stratification of patients with TOF and the need to explore new treatment options to address this problem.

AB - Background: Although there are robust data about the pathophysiology and prognostic implications of left ventricular (LV) systolic dysfunction in patients with acquired heart disease, similar prognostic data about LV systolic dysfunction are sparse in the tetralogy of Fallot (TOF) population. The purpose of this study was to perform a meta-analysis of all studies that assessed the relationship between LV ejection fraction (LVEF) and cardiovascular adverse events (CAEs) defined as death, aborted sudden death, or sustained ventricular tachycardia. Methods: We used random-effects models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Of the 1,809 citations, 7 studies with 2,854 patients (age 28 ± 4 years) were included. During 5.6 ± 3.4 years' follow-up, there were 82 deaths, 17 aborted sudden cardiac deaths, and 56 sustained ventricular tachycardia events. Overall, CAEs occurred in 5.1% (144 patients). As a continuous variable, LVEF was a predictor of CAE (HR 1.29, 95% CI, 1.09-1.53, P = 0.001) per 5% decrease in LVEF. Similarly, LVEF < 40% was also a predictor of CAE (HR 3.22, 95% CI, 2.16-4.80, P < 0.001). Conclusions: LV systolic dysfunction was an independent predictor of CAE, and we observed a 30% increase in the risk of CAE for every 5% decrease in LVEF, and a 3-fold increase in the risk of CAE in patients with LVEF <40% compared with other patients. These findings underscore the importance of incorporating LV systolic function in clinical risk stratification of patients with TOF and the need to explore new treatment options to address this problem.

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