Right Ventricular Contractile Reserve Is Impaired in Children and Adolescents With Repaired Tetralogy of Fallot: An Exercise Strain Imaging Study - 03/01/19
, Yan Wang, RDCS a, Okan U. Elci, PhD b, Elizabeth Goldmuntz, MD a, Michael McBride, PhD a, Stephen Paridon, MD a, Laura Mercer-Rosa, MD, MSCE aAbstract |
Background |
Pulmonary insufficiency (PI) and right ventricular (RV) dysfunction are long-term complications in patients with repaired tetralogy of Fallot (rTOF). The aim of this study was to investigate RV contractile reserve and changes in PI that occur during exercise in patients with rTOF and the associations of these changes with exercise performance using stress echocardiography.
Methods |
Subjects with rTOF (n = 32) and healthy control subjects (n = 10) were prospectively enrolled and underwent rest and peak exercise echocardiography during standard cardiopulmonary exercise test protocol on a cycle ergometer or treadmill. RV contractile reserve was defined as the change in RV global longitudinal strain from rest to peak exercise. PI was assessed with the diastolic-to-systolic time-velocity integral ratio and diastolic/systolic velocity ratio from pulmonary artery Doppler interrogation. Exercise measures included heart rate reserve, percentage predicted maximum oxygen consumption, percentage predicted maximum work, and oxygen pulse.
Results |
RV contractile reserve was impaired in patients with rTOF compared with control subjects, with a significant drop in the absolute value of RV global longitudinal strain from 17% (range, 8%–27%) at rest to 13% (range, 5%–28%) at peak exercise. Similarly, PI decreased at peak exercise, with decreases in diastolic-to-systolic time-velocity integral and diastolic/systolic velocity ratios. Reduction in PI was directly associated with percentage predicted maximum oxygen consumption, percentage predicted maximum work, and greater oxygen pulse. Heart rate reserve was directly associated with percentage predicted maximum oxygen consumption and percentage predicted maximum work. RV contractile reserve was not associated with any exercise parameters.
Conclusions |
Patients with rTOF have an abnormal myocardial response to exercise with impaired RV contractile reserve compared with control subjects. Heart rate reserve and reduction in PI at peak exercise are associated with better exercise performance and appear to be significant contributors to exercise performance in rTOF. Measures to improve chronotropic health in rTOF should be explored.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Exercise stress echocardiography reveals impaired RV contractile reserve in rTOF. |
• | PI decreases significantly at peak exercise in patients with rTOF. |
• | Reduction in PI and heart rate reserve are associated with better exercise capacity. |
• | Measures to improve chronotropic health in rTOF may improve exercise performance. |
Keywords : Tetralogy of Fallot, Contractile reserve, Strain, Exercise stress echocardiography, Congenital heart disease
Abbreviations : %mVo2, %mWork, 2D, CMR, CPET, DSTVI, MPA, PI, rTOF, RV, RVFWS, RVGLS, TOF, Vo2
Plan
| This work was supported by the Children's Hospital of Philadelphia Cardiac Center Grant (L.M.-R. and S.M.B.), the National Institutes of Health (K01HL125521 [L.M.R.], Pulmonary Hypertension Association supplement to K01HL125521 [L.M.R.], National Institutes of Health grant 5T32HL7915-17 [S.M.B.]), and the Matthews Hearts of Hope Foundation Research Grant (S.M.B.). |
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| Conflicts of Interest: None. |
Vol 32 - N° 1
P. 135-144 - janvier 2019 Retour au numéro
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