Assessing late cardiopulmonary function in patients with repaired tetralogy of fallot using exercise cardiopulmonary function test and cardiac magnetic resonance

Ming Chun Yang, Chun An Chen, Hsin Hui Chiu, Ssu Yuan Chen, Jou Kou Wang, Ming Tai Lin, Shuenn Nan Chiu, Chun Wei Lu, Shu Chien Huang, Mei Hwan Wu

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)478-484
Number of pages7
JournalActa Cardiologica Sinica
Volume31
Issue number6
DOIs
Publication statusPublished - Nov 1 2015

Fingerprint

Tetralogy of Fallot
Exercise Test
Pulmonary Valve Insufficiency
Magnetic Resonance Spectroscopy
Oxygen
Exercise
Left Ventricular Function
Stroke Volume
Heart Ventricles
Pulmonary Atresia
Pulmonary Valve
Carbon Dioxide
Oxygen Consumption
Ventilation
Hemodynamics
Magnetic Resonance Imaging

Keywords

  • Cardiac magnetic resonance
  • Cardiopulmonary exercise function
  • Pulmonary regurgitation
  • Surgical age
  • Tetralogy of Fallot

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Assessing late cardiopulmonary function in patients with repaired tetralogy of fallot using exercise cardiopulmonary function test and cardiac magnetic resonance. / Yang, Ming Chun; Chen, Chun An; Chiu, Hsin Hui; Chen, Ssu Yuan; Wang, Jou Kou; Lin, Ming Tai; Chiu, Shuenn Nan; Lu, Chun Wei; Huang, Shu Chien; Wu, Mei Hwan.

In: Acta Cardiologica Sinica, Vol. 31, No. 6, 01.11.2015, p. 478-484.

Research output: Contribution to journalArticle

Yang, Ming Chun ; Chen, Chun An ; Chiu, Hsin Hui ; Chen, Ssu Yuan ; Wang, Jou Kou ; Lin, Ming Tai ; Chiu, Shuenn Nan ; Lu, Chun Wei ; Huang, Shu Chien ; Wu, Mei Hwan. / Assessing late cardiopulmonary function in patients with repaired tetralogy of fallot using exercise cardiopulmonary function test and cardiac magnetic resonance. In: Acta Cardiologica Sinica. 2015 ; Vol. 31, No. 6. pp. 478-484.
@article{74f6193e12774c5081161fa699c1f9b3,
title = "Assessing late cardiopulmonary function in patients with repaired tetralogy of fallot using exercise cardiopulmonary function test and cardiac magnetic resonance",
abstract = "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.",
keywords = "Cardiac magnetic resonance, Cardiopulmonary exercise function, Pulmonary regurgitation, Surgical age, Tetralogy of Fallot",
author = "Yang, {Ming Chun} and Chen, {Chun An} and Chiu, {Hsin Hui} and Chen, {Ssu Yuan} and Wang, {Jou Kou} and Lin, {Ming Tai} and Chiu, {Shuenn Nan} and Lu, {Chun Wei} and Huang, {Shu Chien} and Wu, {Mei Hwan}",
year = "2015",
month = "11",
day = "1",
doi = "10.6515/ACS20150210A",
language = "English",
volume = "31",
pages = "478--484",
journal = "Acta Cardiologica Sinica",
issn = "1011-6842",
publisher = "Republic of China Society of Cardiology",
number = "6",

}

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 - 2015/11/1

Y1 - 2015/11/1

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

UR - http://www.scopus.com/inward/record.url?scp=84958183710&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958183710&partnerID=8YFLogxK

U2 - 10.6515/ACS20150210A

DO - 10.6515/ACS20150210A

M3 - Article

AN - SCOPUS:84958183710

VL - 31

SP - 478

EP - 484

JO - Acta Cardiologica Sinica

JF - Acta Cardiologica Sinica

SN - 1011-6842

IS - 6

ER -