The Right Ventricle and Exercise Capacity in Adults with Repaired Tetralogy of Fallot: Passive Bystander or Active Participant? - 03/03/25
, Chera L. Maarouf, BS, RDCS a, Jessica A. Narum, BS, RDCS a, Timothy J. Fuller, BS, ACS a, James M. Welper, RDCS a, William R. Miranda, MD a, c, C. Charles Jain, MD a, c, Heidi M. Connolly, MD a, c, Luke J. Burchill, MBBS a, c, Alexander C. Egbe, MBBS, MPH a, cAbstract |
Exercise intolerance is a hallmark symptom in adults with tetralogy of Fallot (TOF). This may be attributed to impairments in right ventricular (RV) function, augmentation in RV load, and their effect on left ventricular (LV) hemodynamics. To elucidate these mechanisms, we examined oxygen uptake (VO2) and cardiac hemodynamics in TOF and healthy controls at rest and during exercise. At peak exercise, VO2 was lower in TOF. This was partially attributed to lower heart rate in conjunction with a blunted exercise-induced change in LV stroke volume from rest to compensate for the chronotropic incompetence. Additionally, at peak exercise, pulmonary-RV was higher in TOF. Additionally, at peak exercise, in TOF, pulmonary-RV coupling negatively correlated with VO2 , changes in LV end-diastolic volume, and changes in LV SV from rest. These findings reveal the reliance of LV hemodynamics on the interplay between RV systolic load and function during exercise in TOF.
Le texte complet de cet article est disponible en PDF.Central Illustration |
Illustrative photo of the hemodynamic stress setup, which utilized transthoracic echocardiography for the determination of P-RV coupling and indirect calorimetry for the measurement of VO2. IVC, Inferior vena cava; TTE, transthoracic echocardiogram; VCO2, cardon dioxide produced.
Illustrative photo of the hemodynamic stress setup, which utilized transthoracic echocardiography for the determination of P-RV coupling and indirect calorimetry for the measurement of VO2. IVC, Inferior vena cava; TTE, transthoracic echocardiogram; VCO2, cardon dioxide produced.
Central IllustrationIllustrative photo of the hemodynamic stress setup, which utilized transthoracic echocardiography for the determination of P-RV coupling and indirect calorimetry for the measurement of VO2. IVC, Inferior vena cava; TTE, transthoracic echocardiogram; VCO2, cardon dioxide produced.Le texte complet de cet article est disponible en PDF.
Highlights |
• | Exercise intolerance in TOF may be linked to RV load and dysfunction. |
• | P-RV coupling was higher at peak exercise in TOF compared to controls. |
• | P-RV coupling negatively correlated with VO2 and LV SV reserve at peak exercise. |
• | These findings reveal the reliance of the LV on RV hemodynamics during exercise. |
Keywords : Tetralogy of Fallot, Exercise, Hemodynamics, Right ventricle
Abbreviations : A, ANOVA, BP, CO, CW, Ea, EDA, EDV, Ees, EF, ESA, ESPAR, FWLS, HFpEF, HR, LV, LVOT, MIG, P, PA, PASP, PR, PV, PW, RA, RV, RVOT, RVSP, SBP, SP, SV, TOF, TPV, TR, VCO2, VE, VO2
Plan
| Thomas Kimball, MD, served as guest editor for this report. |
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| Funding: This work was funded by a National Institute of Health/National Heart, Lung, and Blood Institute Research Project grant (R01 HL158517 to A.C.E.). The funding source had no involvement in the collection, analysis, or interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication. |
Vol 38 - N° 3
P. 247-261 - mars 2025 Retour au numéro
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