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.
N1 - Funding Information:
Dr Lumens has received funding from Medtronic Bakken Research Center for consulting services. The remaining authors have no disclosures to report.
Funding Information:
Dr Lumens acknowledges support from the Dr Dekker Program of the Dutch Heart Foundation (grant 2015T082) and the Netherlands Organization for Scientific Research (NWO-ZonMw, VIDI grant 016.176.340).
Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2019/1/22
Y1 - 2019/1/22
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 [KIR], 144 [123-152] ms), at least moderate PR (median [Ilan 40% [29%-48%]), reduced exercise capacity (median [10.R], 79% 168%-92%1 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.
AB - 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 [KIR], 144 [123-152] ms), at least moderate PR (median [Ilan 40% [29%-48%]), reduced exercise capacity (median [10.R], 79% 168%-92%1 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.
KW - computer-based model
KW - pulmonary regurgitation
KW - right ventricular dysfunction
KW - right ventricular dyssynchrony
KW - tetralogy of Fallot
KW - volume overload
KW - VALVE-REPLACEMENT
KW - MECHANICAL DYSSYNCHRONY
KW - MAGNETIC-RESONANCE
KW - SURGICAL REPAIR
KW - CHILDREN
KW - RESYNCHRONIZATION
KW - FAILURE
KW - DEATH
KW - HEART
KW - IMPLANTATION
U2 - 10.1161/JAHA.118.010903
DO - 10.1161/JAHA.118.010903
M3 - Article
C2 - 30651018
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - 010903
ER -