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Cardiopulmonary exercise testing in repaired tetralogy of Fallot and right ventricle dilatation
Session:
Comunicações Orais (Sessão 28) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 3 - Vários Tópicos
Speaker:
Ana Rita Teixeira
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.2 Congenital Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Rita Teixeira; Pedro Garcia Brás; João Ferreira Reis; Tânia Branco Mano; Tiago Rito; Pedro Rio; Sofia Silva; Sónia Coito; Rui Cruz Ferreira; Lídia Sousa
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Background: Long standing pulmonary regurgitation (PR) is a common occurrence after the repair of tetralogy of Fallot (TOF). Exposure of the right ventricle (RV) to a chronic regurgitant load leads to RV dilatation and has been associated with exercise intolerance, arrhythmia, and sudden cardiac death. Our aim was to assess which CPET parameters best correlate with RV dilatation to potentially improve risk stratification of this population.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Methods: </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">A retrospective review was done from 2009 to 2018 on adult patients with repaired TOF who underwent maximal CPET. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected. RV dilatation was defined as an echocardiographically measured basal RV linear diameter > 41 mm and/ or a mid-cavity RV linear diameter >35 mm in the RV-focused view. Multivariate analysis for the prediction of RV dilatation was performed using Cox Regression, by including all statistically significant variables in the univariate analysis and those considered clinically relevant.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Results: CPET was performed in 63 repaired TOF patients (57% male, mean age of 34 ± 9 years), with a mean follow-up of 60 ± 33 months. 56% of patients had severe pulmonary regurgitation and 48% were submitted to pulmonary valve replacement (PVR). 80.4% of repaired TOF patients had RV dilatation, with a mean RER of 1.06 ± 0.08 and a mean peak oxygen uptake of 25.7 ± 6.4 ml/kg/min. These patients had undergone a higher rate of PVR (56.8% vs 11.1%, p = 0.023) and had a higher arrhythmia burden (31.4% vs 0%, p = 0.048), while presenting significantly higher VE/VCO2 slope: 32.0 ± 5.7 vs 28.1 ± 5.l, p= 0.048. A previous PVR (HR 21.06, CI 95% 1.56-28.47, p = 0.022) and VE/VCO2 slope (HR 1.21 CI 95% 1.02-1.47, p = 0.049) were independent predictors of RV dilation. Peak oxygen uptake (p = 0.845) showed no statistically significant correlation with RV dilatation during follow-up.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: <span style="color:black">VE/VCO2 slope was an independent predictor of RV dilatation, thus this CPET parameter may be used to refine risk stratification and improve this population’s follow-up and management. </span></span></span></span></span></p>
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