Adult Congenital Heart Disease

1356981 - Cardiac Magnetic Resonance for Ebstein's Anomaly in a Resource-Limited Setting: Could it Predict the Need for Surgery?

Friday, January 27, 2023

10:20 AM – 11:00 AM

Location: Pacific Jewel

Presenting Author(s)

Carlos-Eduardo Guerrero-Chalela, MD

Cardiac imaging/Adult Congenital Heart Disease
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Distrito Capital de Bogota, Colombia

Primary Author(s)

EV

Eduardo A. Villa-Pallares

Medical Student
Universidad del Rosario
Bogotá, Distrito Capital de Bogota, Colombia

Co-Author(s)

OP

Oscar M. Perez-Fernandez, MD

Clinical Cardiologist
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia
Bogotá, Distrito Capital de Bogota, Colombia
JF

Julian-Francisco Forero-Melo, MD

Cardiac imaging
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Colombia
Laura Acosta Izquierdo, MD

Pediatric Cardiac Imaging Radiologist
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia
Bogota, Cundinamarca, Colombia
CJ

Claudia-Patricia Jaimes-Castellanos, MD

Cardiac imaging
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Colombia
KM

Karen Moreno, MD, MSc

Scientific Articulation and Production Coordinator
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Colombia
NS

Néstor Sandoval, MD

Cardiac Surgeon
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Colombia
IP

Ivonne Pineda, MSc, RN

Registered Nurse
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Colombia
LR

Lina Ramirez, RN

Registered Nurse
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia, Colombia
Héctor M. Medina, MD

Cardiac imaging
Fundación Cardioinfantil–La Cardio, Bogotá, Colombia
Bogotá, Distrito Capital de Bogota, Colombia

Disclosure(s):

Carlos-Eduardo Guerrero-Chalela, MD: No financial relationships to disclose

Laura Acosta Izquierdo, MD: No financial relationships to disclose

Background: Ebstein's anomaly (EA) has become one of the most frequent indications for cardiac magnetic resonance (CMR) in Congenital Heart Disease (CHD). Evidence of CMR markers in EA to predict cardiac surgery is limited, especially in resource-limited settings. (1,2) We aimed to evaluate if CMR-derived parameters could predict the need for surgery in a retrospective single-center cohort of patients with EA.

Methods: Two databases were retrospectively cross-referenced in our institution: The Congenital surgical database and The CMR database. First, patients with diagnosis of EA were identified. Only patients with EA who had undergone CMR were included in the analysis. Patients were divided into two groups according to surgical or non-surgical management for EA. Standardized CMR was analyzed to determine which parameters could be associated with the need of any cardiac surgery. Non-parametric Mann-Whitney U and chi-square tests were applied to evaluate differences. Finally, the receiver operator curve (ROC) and area under the curve (AUC) were calculated to determine the diagnostic yield of significantly associated variables.

Results: Thirty-seven patients with EA were included, with a median age of 24 years. Nineteen (51.3%) were females. The most frequent EA type was C (51.3%). Surgery was performed in 21 patients, with a median age at the moment of surgery of 18 years. The median period between CMR and cardiac surgery was 5 months, most frequent surgical interventions were Cono (61.9%) and tricuspid valve replacement (33.3%). Median right ventricular end-diastolic volume index (RVEDVI) and median right ventricular end-systolic volume index (RVESVi) were significantly (p < 0.05) higher in patients undergoing cardiac surgery as compared to non-surgical patients (median RVEDVi: 174 vs. 101 ml/m2 and median RVESVi 108 vs. 50 ml/m2, respectively). Conversely, left ventricle systolic volume (LVSV) and cardiac output adjusted to height (CI*H) were significantly lower in surgical EA patients as compared to the non-surgical group (LVSV: 50 vs. 58 ml; CI*H: 3.1 vs. 3.64 l/min, respectively) (Table 1). Three variables were associated to surgery in patients with EA (Figure 1): RVEDVi, RVESVi, and tricuspid regurgitation fraction (TRF) with AUC of 0.751, 0.789, and 0.762, respectively. Accordingly, our findings suggest the following cut-off points to consider surgery: RVEDVi: 145 ml/m2, RVESVi: 69,7 ml/m2 and TRF: 41,2% (Table 2).

Conclusion: CMR is a valuable tool for the study of Ebstein's anomaly. Variables that could predict the need for surgery in these patients are RVEDVi, RVESVi, and TRF. In resource-limited settings, precise markers may help dichotomize better need of surgery in EA patients. Further studies are needed to validate these findings and other potential associated variables.