TY - JOUR
T1 - Assessing late cardiopulmonary function in patients with repaired tetralogy of fallot using exercise cardiopulmonary function test and cardiac magnetic resonance
AU - Yang, Ming Chun
AU - Chen, Chun An
AU - Chiu, Hsin Hui
AU - Chen, Ssu Yuan
AU - Wang, Jou Kou
AU - Lin, Ming Tai
AU - Chiu, Shuenn Nan
AU - Lu, Chun Wei
AU - Huang, Shu Chien
AU - Wu, Mei Hwan
PY - 2015/11
Y1 - 2015/11
N2 - Background: Patients with repaired tetralogy of Fallot (TOF) usually experience progressive right ventricle (RV) dysfunction due to pulmonary regurgitation (PR). This could further worsen the cardiopulmonary function. This study aimed to compare the changes in patient exercise cardiopulmonary test and cardiac magnetic resonance imaging, and consider the implication of these changes. Methods: Our study examined repaired TOF patients who underwent cardiopulmonary exercise test (CPET) to obtain maximal (peak oxygen consumption, peak VO2) and submaximal parameters (oxygen uptake efficiency plateau, oxygen uptake efficiency plateau (OUEP), and ratio of minute ventilation to carbon dioxide production, VE/VCO2 slope). Additionally, the hemodynamic statuswas assessed by using cardiacmagnetic resonance. Criteria for exclusion included TOF patients with pulmonary atresia, atrioventricular septal defect, or absence of pulmonary valve syndrome. Results: We enrolled 158 patients whose mean age at repair was 7.8 ± 9.1 years (range 0.1-49.2 years) and the mean patient age at CPETwas 29.5 ± 12.2 years (range 7.0-57.0 years). Severe PR (PR fraction 40%) in 53 patients, moderate in 55, and mild (PR fraction > 20%) in 50 patients were noted. The mean RV end-diastolic volume index (RVEDVi) was 113 ± 35 ml/m2,with 7 patients observed to have a RVEDVi < 163ml/m2. The mean left ventricular ejection fraction (LVEF) was 63 ± 8%, left ventricular end-diastolic volume index (LVEDVi) was 65 ± 12 ml/m2, and LVESVi was 25 ± 14 ml/m2. CPET revealed significantly decreased peak VO2 (68.5 ± 14.4% of predicted), and fair OUEP (90.3 ± 14.1% of predicted) and VE/VCO2 slope (27.1 ± 5.3). PR fraction and age at repair were negatively correlated with maximal and submaximal exercise indicators (peak VO2 and OUEP). Left ventricular (LV) function and size were positively correlated with peak VO2 and OUEP. Conclusions: The results of CPET showed that patients with repaired TOF had a lowmaximal exercise capacity (peak VO2), but a fair submaximal exercise capacity (OUEP and VE/VCO2 slope), suggesting limited exercise capability in high intensity circumstances. PR, LV function and age at total repair were the most important determinants of CPET performance.
AB - Background: Patients with repaired tetralogy of Fallot (TOF) usually experience progressive right ventricle (RV) dysfunction due to pulmonary regurgitation (PR). This could further worsen the cardiopulmonary function. This study aimed to compare the changes in patient exercise cardiopulmonary test and cardiac magnetic resonance imaging, and consider the implication of these changes. Methods: Our study examined repaired TOF patients who underwent cardiopulmonary exercise test (CPET) to obtain maximal (peak oxygen consumption, peak VO2) and submaximal parameters (oxygen uptake efficiency plateau, oxygen uptake efficiency plateau (OUEP), and ratio of minute ventilation to carbon dioxide production, VE/VCO2 slope). Additionally, the hemodynamic statuswas assessed by using cardiacmagnetic resonance. Criteria for exclusion included TOF patients with pulmonary atresia, atrioventricular septal defect, or absence of pulmonary valve syndrome. Results: We enrolled 158 patients whose mean age at repair was 7.8 ± 9.1 years (range 0.1-49.2 years) and the mean patient age at CPETwas 29.5 ± 12.2 years (range 7.0-57.0 years). Severe PR (PR fraction 40%) in 53 patients, moderate in 55, and mild (PR fraction > 20%) in 50 patients were noted. The mean RV end-diastolic volume index (RVEDVi) was 113 ± 35 ml/m2,with 7 patients observed to have a RVEDVi < 163ml/m2. The mean left ventricular ejection fraction (LVEF) was 63 ± 8%, left ventricular end-diastolic volume index (LVEDVi) was 65 ± 12 ml/m2, and LVESVi was 25 ± 14 ml/m2. CPET revealed significantly decreased peak VO2 (68.5 ± 14.4% of predicted), and fair OUEP (90.3 ± 14.1% of predicted) and VE/VCO2 slope (27.1 ± 5.3). PR fraction and age at repair were negatively correlated with maximal and submaximal exercise indicators (peak VO2 and OUEP). Left ventricular (LV) function and size were positively correlated with peak VO2 and OUEP. Conclusions: The results of CPET showed that patients with repaired TOF had a lowmaximal exercise capacity (peak VO2), but a fair submaximal exercise capacity (OUEP and VE/VCO2 slope), suggesting limited exercise capability in high intensity circumstances. PR, LV function and age at total repair were the most important determinants of CPET performance.
KW - Cardiac magnetic resonance
KW - Cardiopulmonary exercise function
KW - Pulmonary regurgitation
KW - Surgical age
KW - Tetralogy of Fallot
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U2 - 10.6515/ACS20150210A
DO - 10.6515/ACS20150210A
M3 - Article
AN - SCOPUS:84958183710
SN - 1011-6842
VL - 31
SP - 478
EP - 484
JO - Acta Cardiologica Sinica
JF - Acta Cardiologica Sinica
IS - 6
ER -