Usefulness of Cardiopulmonary Exercise to Predict Long-Term Prognosis in Adults With Repaired Tetralogy of Fallot

Giardini, Alessandro; Specchia, Salvatore; Tacy, Theresa A.; Coutsoumbas, Gloria Vassilikì; Gargiulo, Gaetano; Donti, Andrea; Formigari, Roberto; Bonvicini, Marco; Picchio, Fernando Maria

doi:10.1016/j.amjcard.2006.12.076

Cited by 143 publications

(97 citation statements)

References 22 publications

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“…A similar pattern was noted for the V E /VCO 2 ratio at the anaerobic threshold, an index of the efficiency of gas exchange similar to the V E /VCO 2 ratio slope, which has been found to be related to prognosis in patients with repaired TOF. 32 We also observed that the post-TPV improvement in peak VO 2 was greatest among patients with the lowest baseline peak VO 2 , with minimal additional contribution of right side of the heart parameters on multivariable analysis. We believe this finding is due, in part, to the fact that, in this patient population, a low peak VO 2 is a consequence of multiple interrelated factors (eg, RV dysfunction, excessive RV pressure, and volume overload) that combine synergistically to impair exercise function.…”

Section: Discussionsupporting

confidence: 57%

Cardiopulmonary exercise function among patients undergoing transcatheter pulmonary valve implantation in the US Melody valve investigational trial

Batra

McElhinney

Wang

et al. 2012

American Heart Journal

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Section: Discussionsupporting

confidence: 57%

Cardiopulmonary exercise function among patients undergoing transcatheter pulmonary valve implantation in the US Melody valve investigational trial

Batra

McElhinney

Wang

et al. 2012

American Heart Journal

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“…The VE/VCO 2 parameter has been shown to be the most powerful predictor of mortality and morbidity in noncyanotic patients with congenital heart disease 25 and in patients with tetralogy of Fallot. 26 Using this normalization in VE/VCO 2 as a clinical outcome, we have demonstrated that those patients who are younger than 17.5 years old, at the time of PVR, are more likely to be left with this exercise parameter within the normal range after surgery. Whether this corresponds with improvement in long-term outlook will have to be the subject of further study.…”

Section: Discussionmentioning

confidence: 99%

Biventricular Response After Pulmonary Valve Replacement for Right Ventricular Outflow Tract Dysfunction

et al. 2008

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Background— The timing of pulmonary valve replacement (PVR) for free pulmonary incompetence in patients with congenital heart disease remains a dilemma for clinicians. We wanted to assess the determinants of improvement after PVR for pulmonary regurgitation over a wide range of patient ages and to use any identified predictors to compare clinical outcomes between patient groups. Methods and Results— Seventy-one patients (mean age 22±11 years; range, 8.5 to 64.9; 72% tetralogy of Fallot) underwent PVR for severe pulmonary regurgitation. New York Heart Association class improved after PVR (median of 2 to 1, P <0.0001). MRI and cardiopulmonary exercise testing were performed before and 1 year after intervention. After PVR, there was a significant reduction in right ventricular volumes (end diastolic volume 142±43 to 91±18, end systolic volume 73±33 to 43±14 mL/m 2 , P <0.0001), whereas left ventricular end diastolic volume increased (66±12 to 73±13 mL/m 2 , P <0.0001). Effective cardiac output significantly increased (right ventricular: 3.0±0.8 to 3.3±0.8 L/min, P =0.013 and left ventricular: 3.0±0.6 to 3.4±0.7 L/min, P <0.0001). On cardiopulmonary exercise testing, ventilatory response to carbon dioxide production at anaerobic threshold improved from 35.9±5.8 to 34.1±6.2 ( P =0.008). Normalization of ventilatory response to carbon dioxide production was most likely to occur when PVR was performed at an age younger than 17.5 years ( P =0.013). Conclusions— A relatively aggressive PVR policy (end diastolic volume <150 mL/m 2 ) leads to normalization of right ventricular volumes, improvement in biventricular function, and submaximal exercise capacity. Normalization of ventilatory response to carbon dioxide production is most likely to occur when surgery is performed at an age ≤17.5 years. This is also associated with a better left ventricular filling and systolic function after surgery.

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“…It is reasonable to presume that patients referred for PVR in the earlier era were at a later stage of disease progression. Their reduced peak oxygen uptake 32,33 or blunted heart rate reserve 34 and increased V .…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing

et al. 2014

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Usefulness of Cardiopulmonary Exercise to Predict Long-Term Prognosis in Adults With Repaired Tetralogy of Fallot

Cited by 143 publications

References 22 publications

Cardiopulmonary exercise function among patients undergoing transcatheter pulmonary valve implantation in the US Melody valve investigational trial

Cardiopulmonary exercise function among patients undergoing transcatheter pulmonary valve implantation in the US Melody valve investigational trial

Biventricular Response After Pulmonary Valve Replacement for Right Ventricular Outflow Tract Dysfunction

Clinical Outcomes of Surgical Pulmonary Valve Replacement After Repair of Tetralogy of Fallot and Potential Prognostic Value of Preoperative Cardiopulmonary Exercise Testing

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