[I-OR08-01] 心臓MRIを用いたファロ―四徴症におけるエネルギー損失の検討
キーワード：4D Flow MRI, TOF, Energy loss
Purpose: To assess energy loss (EL) pattern in adult patients with tetralogy of Fallot (TOF), particularly in TOF with pulmonary stenosis (PS) and pulmonary regurgitation (PR). We also evaluated the association with EL and symptoms in this population.Methods: Prospectively, 66 consecutive TOF adults after intracardiac repair, who underwent four 4D flow mantic resonance imaging (MRI), were enrolled. We defined symptomatic TOF as the following situation: 1) atrial flutter (AFL) and/or atrial tachycardia (AT) occurred within 2 years, which needed medication or ablation, 2) patients developed breathlessness and/or peripheral edema, which required diuretics intake. Results: Eighteen patients were symptomatic. Age, BNP, RVEDVI, LVEDVI were higher and RVEF was lower in symptomatic group than those in asymptomatic one. On a multivariate logistic analysis, diastolic EL/CO was the most important factor of symptom in TOF (odds ratio;7.37, 95%CI; 1.48 to 32.3, P value;0.008). Diastolic EL/CO correlated with RV ejection fraction (EF) and RV systolic pressure. As a sub-analysis, we assessed 31 TOF with moderate PS with PR, and 12 patients were symptomatic. On a multivariate logistic analysis, diastolic EL/CO was also the most important parameter not RV size.Conclusions: Higher EL, particularly, higher diastolic EL/CO, was the important factor of symptom in adults TOF. Higher EL/CO was also related to lower RV EF. Right-sided EL can be a sensitive and useful clinical marker of excessive cardiac workload in adult patients with TOF, beyond the RV size.