Impaired Exercise Tolerance in Repaired Tetralogy of Fallot Is Associated With Impaired Biventricular Contractile Reserve: An Exercise-Stress Real-Time Cardiovascular Magnetic Resonance Study
| Autor: | Joachim Lotz, Andreas Schuster, Matthias Seehase, Christina Unterberg-Buchwald, Shelby Kutty, Matthias J. Müller, Johannes T. Kowallick, Thomas Stümpfig, Martin Uecker, Michael Steinmetz, Thomas Paul |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Ventricular Dysfunction Right 030204 cardiovascular system & hematology Ventricular Function Left Ventricular Dysfunction Left Young Adult 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Magnetic resonance study Humans Radiology Nuclear Medicine and imaging Prospective Studies 030212 general & internal medicine Cardiac Surgical Procedures Tetralogy of Fallot Exercise Tolerance business.industry Reproducibility of Results Exercise stress Middle Aged Exercise capacity medicine.disease Magnetic Resonance Imaging Myocardial Contraction Treatment Outcome medicine.anatomical_structure Case-Control Studies Pulmonary valve Exercise Test Ventricular Function Right Cardiology Female Impaired exercise tolerance Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation: Cardiovascular Imaging. 14 |
| ISSN: | 1942-0080 1941-9651 |
| DOI: | 10.1161/circimaging.120.011823 |
| Popis: | Background: Correction of tetralogy of Fallot (cTOF) often results in pulmonary valve pathology and right ventricular (RV) dysfunction. Reduced exercise capacity in cTOF patients cannot be explained by these findings alone. We aimed to explore why cTOF patients exhibit impaired exercise capacity with the aid of a comprehensive cardiopulmonary exercise testing (CPET) and real-time cardiovascular magnetic resonance exercise testing (CMR-ET) protocol. Methods: Thirty three cTOF patients and 35 matched healthy controls underwent CPET and CMR-ET in a prospective case-control study. Real-time steady-state free precession cine and phase-contrast sequences were obtained during incremental supine in-scanner cycling at 50, 70, and 90 W. RV and left ventricle (LV) volumes and pulmonary blood flow (Qp) were calculated. Differences of CPET and CMR-ET between cTOF versus controls and correlations between CPET and CMR-ET parameters in cTOF were evaluated statistically for all CMR exercise levels using Mann-Whitney U and Spearman rank-order correlation tests. Results: CPET capacity was significantly lower in cTOF than in controls. cTOF patients exhibited not only significantly reduced Qp and RV function but also lower LV function on CMR-ET. Higher CPET values in cTOF correlated with higher Qp (Qp 90 W versus carbon dioxide ventilatory equivalent %: R =−0.519, P R =0.452, P r =−0.463, P r =0.66, P r =0.52, P Conclusions: Impaired exercise capacity in cTOF resulted from a reduction in not only RV, but also LV function. cTOF with good exercise capacity on CPET demonstrated higher LV reserve and pulmonary blood flow during incremental CMR-ET. Apart from RV parameters, CMR-ET–derived LV function could be a valuable tool to stratify cTOF patients for pulmonary valve replacement. |
| Databáze: | OpenAIRE |
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