Pediatric Cardiology

Prediction of prognosis in patients with tetralogy of Fallot based on deep learning imaging analysis

Prediction of prognosis in patients with tetralogy of Fallot based on deep learning imaging analysis Diller GP, Orwat S, Vahle J, Bauer UMM, Urban A, Sarikouch S, Berger F, Beerbaum P, Baumgartner H; German Competence Network for Congenital Heart Defects Investigators. Heart. 2020 Mar 11. pii: heartjnl-2019-315962. doi: 10.1136/heartjnl-2019-315962. [Epub ahead of print] PMID: 32161041 Similar articles Select item 32159755   Take Home Points Machine learning algorithms applied to cardiac magnetic resonance (CMR) images can automatically estimate prognosis in patients with repaired tetralogy of Fallot (ToF) The current study highlights the prognostic value of automatically derived right atrial area and biventricular dysfunction in patients with ToF. Enlarged right atrial median area (HR 1.11/ cm², p=0.003) and reduced right ventricular long-axis strain (HR 0.80/%, p=0.009) was associated with adverse endpoint of death/aborted cardiac arrest or documented ventricular tachycardia (defined as >3 documented consecutive ventricular beats). Machine learning algorithms trained on external imaging datasets can automatically estimate prognosis in patients with ToF.     Comment from Dr. Shaji Menon (Salt Lake City, Utah), Lead Section editor of Pediatric Cardiology Journal Watch: This study assesses the utility of machine learning algorithms for automatically estimating prognosis in patients with repaired tetralogy of Fallot (ToF) using Cardiac magnetic resonance (CMR). The study included 372 patients with ToF who had undergone CMR imaging as part of German National Registry for Congenital Heart Disease between 2003 and 2009. Cine loops were retrieved and subjected to automatic deep learning (DL)-based image analysis, trained on independent, local CMR data, to derive measures of cardiac dimensions and function. This information was combined with established clinical parameters and ECG markers of prognosis. Over a median follow-up period of 10 years, 23 patients experienced an endpoint of death/aborted cardiac arrest or documented ventricular tachycardia (defined as >3 documented consecutive ventricular beats). On univariate Cox analysis, various DL parameters, including right atrial median area (HR 1.11/ cm², p=0.003) and right ventricular long-axis strain (HR 0.80/%, p=0.009) emerged as significant predictors of outcome. DL parameters were related to adverse outcome independently of left and right ventricular ejection fraction and peak oxygen uptake (p<0.05 for all). A composite score of enlarged right atrial area and depressed right ventricular longitudinal function identified a ToF subgroup at significantly increased risk of adverse outcome (HR 2.1/unit, p=0.007). Risk stratification models for patients with ToF have traditionally included a variety of parameters, including age at repair, duration of preoperative cyanosis, previous atrial arrhythmias, QRS duration or fragmentation on ECG, biventricular dysfunction, right atrial area, RV hypertrophy, elevated left ventricular end-diastolic pressure and natriuretic peptides. This study for the first time highlights the prognostic value of automatically derived right atrial area and biventricular dysfunction in patients with ToF.                

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Lifetime cardiovascular management of patients with previous Kawasaki disease

Lifetime cardiovascular management of patients with previous Kawasaki disease Brogan P, Burns JC, Cornish J, Diwakar V, Eleftheriou D, Gordon JB, Gray HH, Johnson TW, Levin M, Malik I, MacCarthy P, McCormack R, Miller O, Tulloh RMR; Kawasaki Disease Writing Group, on behalf of the Royal College of Paediatrics and Child Health, and the British Cardiovascular Society. Heart. 2020 Mar;106(6):411-420. doi: 10.1136/heartjnl-2019-315925. Epub 2019 Dec 16. Review. PMID: 31843876 Free PMC Article Similar articles Select item 31806699   Take Home Points Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients.. Ptients who develop coronary artery aneuryms (CAA) are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. Follow-up in a specialized Kawaski disease clinic with experts in Kawaski diseasee and intervnetional cardiology will help better coordinate care. An adult with a past history of KD and CAA, who presents with any symptoms or signs which could be due to aneurysm thrombosis or acute coronary syndrome, should be transferred promptly to a Heart Attack Centre (HAC). Every child or adult followed-up for CAA should have a person-specific protocol (PSP) written, detailing the pathway of care to be followed if a suspected acute coronary syndrome should occur. This consensus statement from the European Royal College of Paediatrics and Child Health, and the British Cardiovascular Society guidance on th llong-term management of patients who have vascula complications of KD and guidance on the emergency management of acute coronary complications.     Comment from Dr. Shaji Menon (Salt Lake City, Utah), Lead Section Editor of Pediatric Cardiology Journal Watch: Table 1 shows the imaging surveillence protocols for short-term and long-term cornary surveillance and evaluation of myocardial perfusion by level of patient risk. Patients with small or remodelled aneurysms may be seen less frequently, but those with giant aneurysms need regular imaging and assessment to detect developing thrombi within aneurysms, particularly in the early years after the acute KD illness, when the risk of thrombosis is greatest.   Table 2 suggests additional tests to be undertaken during a visit, and in the transition period from paediatric to adult care.    

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