Effect of Right Ventricular Outflow Tract Obstruction on Right Ventricular Volumes and Exercise Capacity in Patients With Repaired Tetralogy of Fallot

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• 作者：Hendrik G. Freling ; Tineke P. Willems ; Joost P. van Melle ; Ymkje J. van Slooten ; Beatrijs Bartelds ; Rolf M.F. Berger ; Dirk J. van Veldhuisen ; Petronella G. Pieper
• 刊名：The American Journal of Cardiology
• 出版年：15 February, 2014
• 年：2014
• 卷：113
• 期：4
• 页码：719-723
• 全文大小：174 K

文摘

Patients with tetralogy of Fallot and combined right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation (PR) have a less dilated right ventricular (RV) and better RV function compared with patients without RVOTO. It is not known whether RVOTO is associated with improved exercise capacity. We compared cardiac magnetic resonance imaging, echocardiography, and exercise tests in 12 patients with RVOTO (Doppler peak RVOT gradient 鈮?0聽mm Hg) and 30 patients without RVOTO. RV end-systolic and end-diastolic volumes were smaller in patients with RVOTO compared with patients without RVOTO (50 卤 16 vs 64 卤 18聽ml/m² and 117 卤 24 vs 135 卤 28聽ml/m², respectively) and patients with RVOTO had a higher RV mass (52 卤 14 vs 42 卤 11聽ml/m²), p <0.05. RV ejection fraction was marginally significantly different between both groups (58 卤 8% vs 53 卤 7%), p聽= 0.051. Degree of PR, left ventricular volumes, and function did not differ significantly between both groups. Peak oxygen uptake in patients with RVOTO was significantly lower (25 卤 3 vs 32 卤 8聽ml/kg/min) than in patients without RVOTO, as was the percentage of predicted peak oxygen uptake (63 卤 7% vs 79 卤 14%), p <0.001. Multivariate analysis showed that the peak RVOT gradient was the only independent predictor of exercise capacity. In conclusion, exercise capacity is lower in patients with RVOTO compared with those without RVOTO despite a less dilated RV and comparable degree of PR. Therefore, exercise capacity may be of importance and should additionally be taken in consideration to RV volumes and function in patients with tetralogy of Fallot and PR.