Impact of pulmonary regurgitation and right ventricular dysfunction on oxygen uptake recovery kinetics in repaired tetralogy of Fallot

Giardini, Alessandro; Specchia, Salvatore; Coutsoumbas, Gloria Vassilikì; Donti, Andrea; Formigari, Roberto; Fattori, Rossella; Oppido, Guido; Gargiulo, Gaetano; Picchio, Fernando Maria

doi:10.1016/j.ejheart.2006.01.012

Cited by 45 publications

(19 citation statements)

References 27 publications

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“…18 Despite the fact that patient symptoms improved significantly in this cohort as previously reported (85% of patients were NYHA Class II-IV pre-TPVI vs. 15% post-TPVI), 13 patients in the current study showed no change in peak VO 2 , VO 2 at AT, or RER after TPVI. This is in line with previous studies that showed similar findings.…”

Section: Discussioncontrasting

confidence: 48%

Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation

Chowdhury

Hijazi

Fahey

et al. 2015

Journal of the American Society of Echocardiography

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Background Speckle-tracking echocardiographic (STE) measures of right ventricular (RV) function appear to improve after transcatheter pulmonary valve (TPV) implantation. Measures of exercise function, such as ventilatory efficiency (the VE/VCO2 slope), have been shown to be prognostic of mortality in patients that may require TPV. Our objective was to evaluate the correlation between STE measures of RV function and changes in VE/VCO2 after TPV placement. Methods STE and cardiopulmonary exercise testing were performed at baseline and 6 months after TPV placement in 24 patients from 4 centers. Conventional echocardiographic measures of RV function were also assessed. Echocardiograms and exercise stress tests were interpreted by single blinded observers at separate Core laboratories. Results All patients demonstrated relief of pulmonary regurgitation and stenosis after TPV implantation. Improvements in RV longitudinal strain (−16.9±3.5% vs. −19.7±4.3%, p<0.01) and strain rate (−0.9±0.4s−1 vs. −1.2±0.4s−1, p<0.01) were noted. The VE/VCO2 slope improved (32.4±5.7 vs. 31.5±8.8, p=0.03). No other significant echo or exercise changes were found. Upon multivariable regression, the change in VE/VCO2 was independently associated with change in RV longitudinal early diastolic strain rate (p<0.001) and tricuspid A velocity (p<0.001). Pre-intervention RV longitudinal strain was found to be a predictor of change in VE/VCO2 after TPVI (r = −0.60, p<0.001). Conclusion STE measures of RV function appear to hold the potential for being used as predictors of improved outcomes in patients requiring TPV implantation. Future studies should directly assess the prognostic significance of STE measures of RV function in this population.

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Section: Discussioncontrasting

confidence: 48%

Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation

Chowdhury

Hijazi

Fahey

et al. 2015

Journal of the American Society of Echocardiography

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“…In response to the regurgitated volume, the RV dilates to overcome the increased loading conditions (1,16). Long-standing PR will eventually lead to dysfunction of the RV, and patients may experience reduced exercise tolerance (17). In such cases, PVR with a competent pulmonary valve provides a satisfactory solution, with excellent short-term results in terms of ventricular function and NYHA functional class (4,18).…”

Section: Discussionmentioning

confidence: 98%

Follow-Up After Pulmonary Valve Replacement in Adults With Tetralogy of Fallot

Scherptong

Hazekamp

Mulder

et al. 2010

Journal of the American College of Cardiology

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“…Indeed, several authors have shown that the kinetics of VO 2 recovery both after the constant-power and the incremental exercise testing are slowed in patients with congenital heart disease and CHF [19,[66][67][68][69]; data for postmyocardial infarction patients are less clear [70,71].…”

Section: Vo 2 Off-kineticsmentioning

confidence: 98%

Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation

Mezzani¹,

Agostoni

Cohen‐Solal

et al. 2009

European Journal of Cardiovascular Prevention & Rehabilitat

340

301

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Cardiopulmonary exercise testing (CPET) is a methodology that has profoundly affected the approach to patients' functional evaluation, linking performance and physiological parameters to the underlying metabolic substratum and providing highly reproducible exercise capacity descriptors. This study provides professionals with an up-to-date review of the rationale sustaining the use of CPET for functional evaluation of cardiac patients in both the clinical and research settings, describing parameters obtainable either from ramp incremental or step constant-power CPET and illustrating the wealth of information obtainable through an experienced use of this powerful tool. The choice of parameters to be measured will depend on the specific goals of functional evaluation in the individual patient, namely, exercise tolerance assessment, training prescription, treatment efficacy evaluation, and/or investigation of exercise-induced adaptations of the oxygen transport/utilization system. The full potentialities of CPET in the clinical and research setting still remain largely underused and strong efforts are recommended to promote a more widespread use of CPET in the functional evaluation of cardiac patients.

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Impact of pulmonary regurgitation and right ventricular dysfunction on oxygen uptake recovery kinetics in repaired tetralogy of Fallot

Abstract: In ToF patients, severe PR and RV dysfunction lead to delayed recovery from exercise. CPX can identify patients with severe PR and RV dysfunction and may be useful to guide the pulmonary valve replacement decision-making process.

Cited by 45 publications

References 27 publications

Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation

Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation

Follow-Up After Pulmonary Valve Replacement in Adults With Tetralogy of Fallot

Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation

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