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Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation on Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot.
J Am Heart Assoc. 2019 01 22; 8(2):e010903.JA

Abstract

Background The relative impact of right ventricular (RV) electromechanical dyssynchrony versus pulmonary regurgitation (PR) on exercise capacity and RV function after tetralogy of Fallot repair is unknown. We aimed to delineate the relative effects of these factors on RV function and exercise capacity. Methods and Results We retrospectively analyzed 81 children with tetralogy of Fallot repair using multivariable regression. Predictor parameters were electrocardiographic QRS duration reflecting electromechanical dyssynchrony and PR severity by cardiac magnetic resonance. The outcome parameters were exercise capacity (percentage predicted peak oxygen consumption) and cardiac magnetic resonance ejection fraction (RV ejection fraction). To understand the relative effects of RV dyssynchrony versus PR on exercise capacity and RV function, virtual patient simulations were performed using a closed-loop cardiovascular system model (CircAdapt), covering a wide spectrum of disease severity. Eighty-one patients with tetralogy of Fallot repair (median [interquartile range { IQR} ] age, 14.48 [11.55-15.91] years) were analyzed. All had prolonged QRS duration (median [IQR], 144 [123-152] ms), at least moderate PR (median [IQR], 40% [29%-48%]), reduced exercise capacity (median [IQR], 79% [68%-92%] predicted peak oxygen consumption), and reduced RV ejection fraction (median [IQR], 48% [44%-52%]). Longer QRS duration, more than PR , was associated with lower oxygen consumption and lower RV ejection fraction. In a multivariable regression analysis, oxygen consumption decreased with both increasing QRS duration and PR severity. CircAdapt modeling showed that RV dyssynchrony exerts a stronger limiting effect on exercise capacity and on RV ejection fraction than does PR , regardless of contractile function. Conclusions In both patient data and computer simulations, RV dyssynchrony, more than PR , appears to be associated with reduced exercise capacity and RV systolic dysfunction in patients after TOF repair.

Authors+Show Affiliations

2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands. 3 IHU LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Pessac France.1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada.2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands.1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada.1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada.1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada.1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada.1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada.4 Department of Physiology Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands.2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands.1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30651018

Citation

Lumens, Joost, et al. "Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation On Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot." Journal of the American Heart Association, vol. 8, no. 2, 2019, pp. e010903.
Lumens J, Fan CS, Walmsley J, et al. Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation on Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot. J Am Heart Assoc. 2019;8(2):e010903.
Lumens, J., Fan, C. S., Walmsley, J., Yim, D., Manlhiot, C., Dragulescu, A., Grosse-Wortmann, L., Mertens, L., Prinzen, F. W., Delhaas, T., & Friedberg, M. K. (2019). Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation on Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot. Journal of the American Heart Association, 8(2), e010903. https://doi.org/10.1161/JAHA.118.010903
Lumens J, et al. Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation On Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot. J Am Heart Assoc. 2019 01 22;8(2):e010903. PubMed PMID: 30651018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation on Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot. AU - Lumens,Joost, AU - Fan,Chun-Po Steve, AU - Walmsley,John, AU - Yim,Deane, AU - Manlhiot,Cedric, AU - Dragulescu,Andreea, AU - Grosse-Wortmann,Lars, AU - Mertens,Luc, AU - Prinzen,Frits W, AU - Delhaas,Tammo, AU - Friedberg,Mark K, PY - 2019/1/18/entrez PY - 2019/1/18/pubmed PY - 2020/1/4/medline KW - computer‐based model KW - pulmonary regurgitation KW - right ventricular dysfunction KW - right ventricular dyssynchrony KW - tetralogy of Fallot KW - volume overload SP - e010903 EP - e010903 JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 8 IS - 2 N2 - Background The relative impact of right ventricular (RV) electromechanical dyssynchrony versus pulmonary regurgitation (PR) on exercise capacity and RV function after tetralogy of Fallot repair is unknown. We aimed to delineate the relative effects of these factors on RV function and exercise capacity. Methods and Results We retrospectively analyzed 81 children with tetralogy of Fallot repair using multivariable regression. Predictor parameters were electrocardiographic QRS duration reflecting electromechanical dyssynchrony and PR severity by cardiac magnetic resonance. The outcome parameters were exercise capacity (percentage predicted peak oxygen consumption) and cardiac magnetic resonance ejection fraction (RV ejection fraction). To understand the relative effects of RV dyssynchrony versus PR on exercise capacity and RV function, virtual patient simulations were performed using a closed-loop cardiovascular system model (CircAdapt), covering a wide spectrum of disease severity. Eighty-one patients with tetralogy of Fallot repair (median [interquartile range { IQR} ] age, 14.48 [11.55-15.91] years) were analyzed. All had prolonged QRS duration (median [IQR], 144 [123-152] ms), at least moderate PR (median [IQR], 40% [29%-48%]), reduced exercise capacity (median [IQR], 79% [68%-92%] predicted peak oxygen consumption), and reduced RV ejection fraction (median [IQR], 48% [44%-52%]). Longer QRS duration, more than PR , was associated with lower oxygen consumption and lower RV ejection fraction. In a multivariable regression analysis, oxygen consumption decreased with both increasing QRS duration and PR severity. CircAdapt modeling showed that RV dyssynchrony exerts a stronger limiting effect on exercise capacity and on RV ejection fraction than does PR , regardless of contractile function. Conclusions In both patient data and computer simulations, RV dyssynchrony, more than PR , appears to be associated with reduced exercise capacity and RV systolic dysfunction in patients after TOF repair. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/30651018/Relative_Impact_of_Right_Ventricular_Electromechanical_Dyssynchrony_Versus_Pulmonary_Regurgitation_on_Right_Ventricular_Dysfunction_and_Exercise_Intolerance_in_Patients_After_Repair_of_Tetralogy_of_Fallot_ L2 - https://www.ahajournals.org/doi/10.1161/JAHA.118.010903?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -