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Abstract：
BACKGROUND: Patients with unbalanced common atrioventricular canal can be difficult to manage. Surgical planning often depends on pre-operative echocardiographic measurements. We aimed to determine the added utility of cardiac MRI in predicting successful biventricular repair in common atrioventricular canal.
METHODS: We conducted a retrospective cohort study of children with common atrioventricular canal who underwent MRI prior to repair. Associations between MRI and echocardiographic measures and surgical outcome were tested using logistic regression, and models were compared using area under the receiver operator characteristic curve.
RESULTS: We included 28 patients (median age at MRI: 5.2 months). The optimal MRI model included the novel end-diastolic volume index (using the ratio of left ventricular end-diastolic volume to total end-diastolic volume) and the left ventricle-right ventricle angle in diastole (area under the curve 0.83, p = 0.041). End-diastolic volume index ≤ 0.18 and left ventricle-right ventricle angle in diastole ≤ 72° yield a sensitivity of 83% and specificity of 81% for successful biventricular repair. The optimal multimodality model included the end-diastolic volume index and the echocardiographic atrioventricular valve index with an area under the curve of 0.87 (p = 0.026).
CONCLUSIONS: Cardiac MRI can successfully predict successful biventricular repair in patients with unbalanced common atrioventricular canal utilising the end-diastolic volume index alone or in combination with the MRI left ventricle-right ventricle angle in diastole or the echocardiographic atrioventricular valve index. A prospective cardiac MRI study is warranted to better define the multimodality characteristic predictive of successful biventricular surgery.
METHODS: We conducted a retrospective cohort study of children with common atrioventricular canal who underwent MRI prior to repair. Associations between MRI and echocardiographic measures and surgical outcome were tested using logistic regression, and models were compared using area under the receiver operator characteristic curve.
RESULTS: We included 28 patients (median age at MRI: 5.2 months). The optimal MRI model included the novel end-diastolic volume index (using the ratio of left ventricular end-diastolic volume to total end-diastolic volume) and the left ventricle-right ventricle angle in diastole (area under the curve 0.83, p = 0.041). End-diastolic volume index ≤ 0.18 and left ventricle-right ventricle angle in diastole ≤ 72° yield a sensitivity of 83% and specificity of 81% for successful biventricular repair. The optimal multimodality model included the end-diastolic volume index and the echocardiographic atrioventricular valve index with an area under the curve of 0.87 (p = 0.026).
CONCLUSIONS: Cardiac MRI can successfully predict successful biventricular repair in patients with unbalanced common atrioventricular canal utilising the end-diastolic volume index alone or in combination with the MRI left ventricle-right ventricle angle in diastole or the echocardiographic atrioventricular valve index. A prospective cardiac MRI study is warranted to better define the multimodality characteristic predictive of successful biventricular surgery.
摘要：
背景：常见房室管不平衡的患者可能难以管理。手术计划通常取决于术前超声心动图测量。我们旨在确定心脏MRI在预测常见房室管双心室修复成功中的附加效用。
方法：我们进行了一项回顾性队列研究，研究对象是在房室道修复前接受MRI检查的儿童。MRI和超声心动图测量与手术结果之间的关联使用logistic回归进行测试。和模型使用接收器操作员特征曲线下的面积进行比较。
结果：我们纳入了28例患者（MRI中位年龄：5.2个月）。最佳MRI模型包括新的舒张末期容积指数（使用左心室舒张末期容积与总舒张末期容积的比率）和舒张期左心室-右心室角度（曲线下面积0.83，p=0.041）。对于成功的双心室修复，舒张末期容积指数≤0.18和左心室-右心室角≤72°的敏感性为83％，特异性为81％。最佳多模态模型包括舒张末期容积指数和超声心动图房室瓣指数，曲线下面积为0.87（p=0.026）。
结论：心脏MRI可以单独使用舒张末期容积指数或与MRI左心室-右心室舒张角或超声心动图房室瓣指数联合使用，成功预测房室道不平衡患者的双心室修复成功。有必要进行前瞻性心脏MRI研究，以更好地定义预测双心室手术成功的多模态特征。
方法：我们进行了一项回顾性队列研究，研究对象是在房室道修复前接受MRI检查的儿童。MRI和超声心动图测量与手术结果之间的关联使用logistic回归进行测试。和模型使用接收器操作员特征曲线下的面积进行比较。
结果：我们纳入了28例患者（MRI中位年龄：5.2个月）。最佳MRI模型包括新的舒张末期容积指数（使用左心室舒张末期容积与总舒张末期容积的比率）和舒张期左心室-右心室角度（曲线下面积0.83，p=0.041）。对于成功的双心室修复，舒张末期容积指数≤0.18和左心室-右心室角≤72°的敏感性为83％，特异性为81％。最佳多模态模型包括舒张末期容积指数和超声心动图房室瓣指数，曲线下面积为0.87（p=0.026）。
结论：心脏MRI可以单独使用舒张末期容积指数或与MRI左心室-右心室舒张角或超声心动图房室瓣指数联合使用，成功预测房室道不平衡患者的双心室修复成功。有必要进行前瞻性心脏MRI研究，以更好地定义预测双心室手术成功的多模态特征。
