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Title: Assessment of left ventricular preload by cardiac magnetic resonance imaging predicts exercise capacity in adult operated tetralogy of Fallot: A retrospective study
Authors: Yap J.
Le Tan J. 
Le T.T. 
Gao F. 
Zhong L. 
Liew R. 
Tan S.Y. 
Tan R.S. 
Keywords: beta adrenergic receptor blocking agent
dipeptidyl carboxypeptidase inhibitor
diuretic agent
anaerobic threshold
cardiopulmonary exercise test
cardiovascular magnetic resonance
cardiovascular parameters
controlled study
Fallot tetralogy
functional status
heart left ventricle
heart left ventricle enddiastolic volume
heart muscle oxygen consumption
heart preload
heart right ventricle enddiastolic volume
heart stroke volume
major clinical study
nuclear magnetic resonance scanner
postoperative period
pulse rate
respiratory tract parameters
retrospective study
surgical patient
systolic blood pressure
exercise test
exercise tolerance
heart left ventricle function
heart right ventricle function
heart surgery
nuclear magnetic resonance imaging
oxygen consumption
predictive value
pulmonary valve insufficiency
Tetralogy of Fallot
treatment outcome
young adult
Cardiac Surgical Procedures
Exercise Test
Exercise Tolerance
Magnetic Resonance Imaging, Cine
Oxygen Consumption
Predictive Value of Tests
Pulmonary Valve Insufficiency
Retrospective Studies
Tetralogy of Fallot
Time Factors
Treatment Outcome
Ventricular Function, Left
Ventricular Function, Right
Young Adult
Issue Date: 2014
Publisher: BioMed Central Ltd.
Citation: Yap J., Le Tan J., Le T.T., Gao F., Zhong L., Liew R., Tan S.Y., Tan R.S. (2014). Assessment of left ventricular preload by cardiac magnetic resonance imaging predicts exercise capacity in adult operated tetralogy of Fallot: A retrospective study. BMC Cardiovascular Disorders 14 (1) : 122. ScholarBank@NUS Repository.
Abstract: Background: The optimal timing of pulmonary homograft valve replacement (PVR) is uncertain. Cardiopulmonary exercise testing (CPET) and cardiac magnetic resonance (CMR) are often used to guide the clinical decision for PVR in operated tetralogy of Fallot (TOF) patients with significant pulmonary regurgitation (PR). We aim to study the relationship between exercise capacity and CMR in these patients.Methods: The study is a single-centre retrospective analysis of 36 operated TOF patients [median 21.4 (interquartile range 16.4, 26.4) years post-repair; 30 NYHA I, 6 NYHA II; median age 25.2 (interquartile range 19.5-31.7) years, 29 males] with significant PR on CMR who underwent CPET within 15 [median 2.0 (interquartile range 0.8-7.2)] months from CMR. CPET parameters were compared with 30 age- and sex-matched healthy controls [median age 27.8 (interquartile range 21.0-32.8) years; 24 males].Results: Peak systolic blood pressure (177 versus 192 mmHg, p = 0.007), Mets (7.3 versus 9.9, p < 0.001), peak oxygen consumption (VO2max) (29.2 versus 34.5 ml/kg/min, p < 0.001) and peak oxygen pulse (11.0 versus 13.7 ml/beat, p = 0.003) were significantly lower in TOF group versus control. Univariate analyses showed negative correlation between PR fraction and anaerobic threshold. There was a positive correlation between indexed left (LV) and right (RV) ventricular end-diastolic volumes, as well as indexed LV and effective RV stroke volumes, on CMR and VO2max and Mets achieved on CPET. These remained significant after adjustment for age and sex.Conclusions: TOF subjects have near normal exercise capacity but significantly lower Mets, VO2max and peak oygen pulse achieved compared to controls. Increased PR fraction in TOF subjects was associated with lower anaerobic threshold. Higher indexed effective RV stroke volume, a measure of LV preload, was associated with higher VO2max and Mets achieved, and may potentially be used as a predictor of exercise capacity. © 2014 Yap et al.; licensee BioMed Central Ltd.
Source Title: BMC Cardiovascular Disorders
ISSN: 14712261
DOI: 10.1186/1471-2261-14-122
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