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Exercise stress echocardiographic assessment of outflow tract and ventricular function in patients with an obstructed right ventricular-to-pulmonary artery conduit after repair of conotruncal heart defects.
Am J Cardiol. 2012 Nov 15; 110(10):1527-33.AJ

Abstract

This study assessed right ventricular (RV) and RV outflow tract (RVOT) function and pressure in response to exercise in patients with an obstructed RV-pulmonary artery (PA) conduit using exercise stress echocardiography (ESE) to evaluate these parameters. RV-PA conduits inevitably develop stenosis and/or regurgitation over time. Assessment of conduit obstruction only at rest may not reveal the extent of physiologic perturbation related to RV pressure loading. Patients with a stenotic RV-PA conduit who were being considered for transcatheter pulmonary valve placement were approached prospectively. ESE was performed and ventricular images were obtained at rest and at peak exercise. Forty patients (median age 17 years) were enrolled. Most patients had tetralogy of Fallot (63%) and were in New York Heart Association class II (59%). Exercise stress echocardiographic images were adequate in 38 patients (95%). With exercise there was a significant increase in maximum instantaneous RVOT gradient from rest (59 vs 96 mm Hg, p <0.001); exercise-induced change in RVOT gradient correlated with global RV strain at rest (r = -0.3, p = 0.05). Compared to measurements at rest there were significant increases in median peak longitudinal strain of the left ventricular free wall, interventricular septum, and global left ventricular strain at peak exercise. There were no significant changes in median RV strain at peak exercise (RV free wall -14.3 [-26, -8] at rest vs -15.2 [-27, -3] at peak exercise, p = 0.87; global RV strain -13.9 [-32, -9] vs -15.1 [-23, -6], p = 0.11). In conclusion, using ESE it was possible to evaluate abnormal ventricular function and conduit dysfunction at peak exercise in patients with an obstructed RV-PA conduit.

Authors+Show Affiliations

Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. babar.hasan@aku.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22858182

Citation

Hasan, Babar Sultan, et al. "Exercise Stress Echocardiographic Assessment of Outflow Tract and Ventricular Function in Patients With an Obstructed Right Ventricular-to-pulmonary Artery Conduit After Repair of Conotruncal Heart Defects." The American Journal of Cardiology, vol. 110, no. 10, 2012, pp. 1527-33.
Hasan BS, Lunze FI, McElhinney DB, et al. Exercise stress echocardiographic assessment of outflow tract and ventricular function in patients with an obstructed right ventricular-to-pulmonary artery conduit after repair of conotruncal heart defects. Am J Cardiol. 2012;110(10):1527-33.
Hasan, B. S., Lunze, F. I., McElhinney, D. B., Stantcheva, E., Brown, D. W., Rhodes, J., & Chen, M. H. (2012). Exercise stress echocardiographic assessment of outflow tract and ventricular function in patients with an obstructed right ventricular-to-pulmonary artery conduit after repair of conotruncal heart defects. The American Journal of Cardiology, 110(10), 1527-33. https://doi.org/10.1016/j.amjcard.2012.07.013
Hasan BS, et al. Exercise Stress Echocardiographic Assessment of Outflow Tract and Ventricular Function in Patients With an Obstructed Right Ventricular-to-pulmonary Artery Conduit After Repair of Conotruncal Heart Defects. Am J Cardiol. 2012 Nov 15;110(10):1527-33. PubMed PMID: 22858182.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exercise stress echocardiographic assessment of outflow tract and ventricular function in patients with an obstructed right ventricular-to-pulmonary artery conduit after repair of conotruncal heart defects. AU - Hasan,Babar Sultan, AU - Lunze,Fatima Iljinichna, AU - McElhinney,Doff B, AU - Stantcheva,Eugeniya, AU - Brown,David W, AU - Rhodes,Jonathan, AU - Chen,Ming Hui, Y1 - 2012/08/02/ PY - 2012/04/25/received PY - 2012/07/10/revised PY - 2012/07/10/accepted PY - 2012/8/4/entrez PY - 2012/8/4/pubmed PY - 2013/1/9/medline SP - 1527 EP - 33 JF - The American journal of cardiology JO - Am J Cardiol VL - 110 IS - 10 N2 - This study assessed right ventricular (RV) and RV outflow tract (RVOT) function and pressure in response to exercise in patients with an obstructed RV-pulmonary artery (PA) conduit using exercise stress echocardiography (ESE) to evaluate these parameters. RV-PA conduits inevitably develop stenosis and/or regurgitation over time. Assessment of conduit obstruction only at rest may not reveal the extent of physiologic perturbation related to RV pressure loading. Patients with a stenotic RV-PA conduit who were being considered for transcatheter pulmonary valve placement were approached prospectively. ESE was performed and ventricular images were obtained at rest and at peak exercise. Forty patients (median age 17 years) were enrolled. Most patients had tetralogy of Fallot (63%) and were in New York Heart Association class II (59%). Exercise stress echocardiographic images were adequate in 38 patients (95%). With exercise there was a significant increase in maximum instantaneous RVOT gradient from rest (59 vs 96 mm Hg, p <0.001); exercise-induced change in RVOT gradient correlated with global RV strain at rest (r = -0.3, p = 0.05). Compared to measurements at rest there were significant increases in median peak longitudinal strain of the left ventricular free wall, interventricular septum, and global left ventricular strain at peak exercise. There were no significant changes in median RV strain at peak exercise (RV free wall -14.3 [-26, -8] at rest vs -15.2 [-27, -3] at peak exercise, p = 0.87; global RV strain -13.9 [-32, -9] vs -15.1 [-23, -6], p = 0.11). In conclusion, using ESE it was possible to evaluate abnormal ventricular function and conduit dysfunction at peak exercise in patients with an obstructed RV-PA conduit. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/22858182/Exercise_stress_echocardiographic_assessment_of_outflow_tract_and_ventricular_function_in_patients_with_an_obstructed_right_ventricular_to_pulmonary_artery_conduit_after_repair_of_conotruncal_heart_defects_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(12)01729-8 DB - PRIME DP - Unbound Medicine ER -