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Cardiopulmonary Exercise Testing in Repaired Tetralogy of Fallot - Assessing pulmonary regurgitation
Session:
Sessão de Comunicações Orais - Hipertensão Pulmonar e Congénitos
Speaker:
Pedro Brás
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.3 Congenital Heart Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Garcia Brás; André Viveiros Monteiro; Lidia De Sousa; Rita Ilhão Moreira; Tânia Branco Mano; Pedro Rio; Isabel Gonçalves Machado Cardoso; André Grazina; Sofia Silva; Carina Martins; Sónia Coito; Eunice Capilé; Ana Figueiredo Agapito; Rui Cruz Ferreira
Abstract
<p><strong>Introduction and purpose:</strong> The optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with repaired Tetralogy of Fallot (TOF) and pulmonary regurgitation (PR) remains uncertain but is often guided by imaging characterization of the right ventricle. As cardiopulmonary exercise testing (CPET) performance is a strong and an accessible prognostic indicator, we assessed which CPET parameters best correlate with pulmonary regurgitation severity to potentially improve identification of high-risk patients.</p> <p><strong>Methods:</strong> A retrospective chart review was done from 2009 to 2018 on patients with TOF who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected.</p> <p><strong>Results:</strong> Cardiopulmonary exercise test was performed in 54 TOF patients (59% male), with a mean age of 34±9 years. 30 patients (56%) had severe pulmonary regurgitation and 26 patients (48%) were submitted to PVR, with a 0% mortality rate. PVR was performed a mean 28±7 years after TOF repair surgery. There was moderate to severe right ventricular dysfunction in 11 patients (20%).12 patients (22%) had a hospitalization for heart failure. Arrhythmic events occurred in 9 patients (17%), mainly atrial fibrillation or atrial flutter (67%). 2 patients (4%) received an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death.</p> <p>Peak VO<sub>2</sub> consumption (pVO<sub>2</sub>) showed no statistically significant correlation with severity of pulmonary regurgitation (HR 0.26, CI 0.879-1.036, p=0.262) or PVR (HR 0.92, CI 0.829-1.028, p=0.914), while percent of predicted pVO<sub>2</sub> significantly correlated with severity of pulmonary regurgitation (HR 1.05, CI 1.007-1.089, p=0.020) and PVR (HR 1.06, CI 1.008-1.129, p=0.025).</p> <p>Cardiorespiratory optimal point (HR 0.94, CI 0.786-1.120, p=0.480) and maximum end-tidal carbon dioxide pressure (HR 1.07, CI 0.964-1.182, p=0.213) also did not correlate with pulmonary regurgitation or PVR.</p> <p><strong>Conclusion:</strong> Percent of predicted peak VO<sub>2 </sub>had the highest predictive power of all CPET parameters analysed in adult TOF patients. Preoperative CPET could be an accessible way to identify sooner high-risk patients for PVR and should therefore be included in the routine assessment of these patients.</p>
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