scholarly journals Cardiopulmonary exercise testing for evaluation of a randomized exercise training intervention following aortic valve replacement

2018 ◽  
Vol 39 (1) ◽  
pp. 103-110 ◽  
Author(s):  
Henric Nilsson ◽  
Eva Nylander ◽  
Sabina Borg ◽  
Éva Tamás ◽  
Kristofer Hedman
Keyword(s):  
Aortic Valve ◽  
Exercise Training ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Training Intervention ◽  
Cardiopulmonary Exercise ◽  
Exercise Training Intervention

Outcomes of adults with repaired tetralogy of Fallot from the national Scottish Cohort

2021 ◽  
pp. 1-9
Author(s):  
Richard J. Dobson ◽  
Nitish Ramparsad ◽  
Niki L. Walker ◽  
Alex McConnachie ◽  
Mark H. D. Danton
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Exercise Testing ◽  
Primary Outcome ◽  
Pulmonary Valve ◽  
Cardiopulmonary Exercise Testing ◽  
Pulmonary Valve Replacement ◽  
Cardiopulmonary Exercise ◽  
End Diastolic Volume ◽  
Repaired Tetralogy Of Fallot

Abstract Background: The adult population of repaired tetralogy of Fallot is increasing and at risk of pre-mature death and arrhythmia. This study evaluates risk factors for adverse outcome and the effect of pulmonary valve replacement within a national cohort. Methods: A retrospective cohort study of 341 adult repaired tetralogy of Fallot (16–72 years) managed through a single national service was undertaken incorporating over 1200 patient-years of follow-up. Demographics, cardiopulmonary exercise testing, cardiac magnetic resonance, reintervention (including pulmonary valve replacement), and clinical events were analysed. The influence of these parameters on a primary outcome (death or arrhythmia) was evaluated. Results: Compared with an age-/gender-matched population, patients experienced a reduced survival, particularly males over 55 years (standardised mortality ratio : 6.12, 95% CI: 1.64–15.66, p = 0.004). Cox proportional hazards modelling identified increased indexed right ventricle (RV) end-diastolic volume (hazard ratio (HR): 2.86, 95% CI: 1.4–5.85, p = 0.004) and female gender (HR (male): 0.37, 95% CI: 0.14–0.98, p = 0.045) to be predictors significantly associated with the primary outcome. Pulmonary valve replacement undertaken at indexed RV end-diastolic volume = 145 ml/m2 reduced RV volumes and QRS duration but did not improve cardiopulmonary exercise testing nor NYHA class. Pulmonary valve replacement during cohort period was associated with increased risk of primary outcome (HR: 2.82, 95% CI: 1.36–5.86, p = 0.005). Conclusions: Although the majority of adult tetralogy of Fallot were asymptomatic in NYHA 1, cardiopulmonary exercise testing revealed important deficits. Tetralogy of Fallot survival was reduced compared to the general population. Female gender and increasing RV end-diastolic volume predicted adverse events. Pulmonary valve replacement reduced RV volumes and QRS duration but did not improve primary outcome.

scholarly journals Cardiopulmonary Exercise Testing in Patients with Asymptomatic or Equivocal Symptomatic Aortic Stenosis: Feasibility, Reproducibility, Safety and Information Obtained on Exercise Physiology

Cardiology ◽  
2015 ◽  
Vol 133 (3) ◽  
pp. 147-156 ◽  
Author(s):  
Douet van Le ◽  
Gunnar Vagn Hagemann Jensen ◽  
Steen Carstensen ◽  
Lars Kjøller-Hansen
Keyword(s):  
Aortic Stenosis ◽  
Stroke Volume ◽  
Valve Replacement ◽  
Exercise Testing ◽  
Comprehensive Evaluation ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Aortic Valve Area ◽  
Cardiopulmonary Exercise ◽  
O2 Pulse

Objective: The aim of this study was to determine the feasibility, reproducibility, safety and information obtained on exercise physiology from cardiopulmonary exercise testing (CPX) in patients with aortic stenosis. Methods: Patients with an aortic valve area (AVA) <1.3 cm2 who were judged asymptomatic or equivocal symptomatic underwent CPX and an inert gas rebreathing test. Only those where comprehensive evaluation of CPX results indicated haemodynamic compromise from aortic stenosis were referred for valve replacement. Results: The mean patient age was 72 (±9) years; an AVA index <0.6 cm2/m2 and equivocal symptomatic status were found in 90 and 70%, respectively. CPX was feasible in 130 of the 131 patients. The coefficients of repeatability by test-retest were 5.4% (pVO2) and 4.6% (peak O2 pulse). A pVO2 <83% of the expected was predicted by a lower stroke volume at exercise, lower peak heart rate and FEV1, and higher VE/VCO2, but not by AVA index. Equivocal symptomatic status and a low gradient but high valvulo-arterial impedance were associated with a lower pVO2, but not with an inability to increase stroke volume. In total, 18 patients were referred for valve replacement. At 1 year, no cardiovascular deaths had occurred. Conclusions: CPX was feasible and reproducible and provided comprehensive data on exercise physiology. A CPX-guided treatment strategy was safe up to 1 year.

Pulmonary effects on exercise testing in tetralogy of Fallot patients repaired with a transannular patch

2018 ◽  
Vol 29 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Adam W. Powell ◽  
Wayne A. Mays ◽  
Sandra K. Knecht ◽  
Clifford Chin
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Exercise Testing ◽  
Pulmonary Valve ◽  
Cardiopulmonary Exercise Testing ◽  
Pulmonary Valve Replacement ◽  
Cardiopulmonary Exercise ◽  
Transannular Patch ◽  
Function Testing ◽  
Normal Controls

AbstractBackgroundA transannular patch is often used in the contemporary surgical repair of tetralogy of Fallot. This can lead to significant pulmonary insufficiency and increased right ventricular volumes and ultimately pulmonary valve replacement. Cardiopulmonary exercise testing is used to assess exercise capacity in tetralogy of Fallot patients before pulmonary valve replacement. There is only few published literatures on how lung function affects functional capacity in tetralogy of Fallot patients repaired with a transannular patch.MethodsA retrospective chart review was done from 2015 to 2017 on patients with tetralogy of Fallot who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Tetralogy of Fallot patients repaired with a transannular patch without pulmonary valve replacement were compared with age, gender, and size-matched normal controls.ResultsIn the tetralogy of Fallot group, 24 out of 57 patients underwent primary repair with a transannular patch. When compared to the normal controls, they demonstrated abnormal predicted forced expiratory volume in one second (79 ± 23.1% versus 90.7 ± 14.1%, p<0.05), predicted maximal voluntary ventilation (74 ± 18% versus 90.5 ± 16.2%, p<0.05) while having low-normal predicted forced vital capacity (80.5 ± 17.2% versus 90.2 ± 12.4%, p<0.05) and normal breathing reserve percentage (50.3 ± 11.3% versus 47.5 ± 17.3%, p = 0.52). Cardiopulmonary exercise testing abnormalities included significantly lower percent predicted oxygen consumption (63.2 ± 12.2% versus 87 ± 12.1%, p<0.05), maximal heart rate (171.8 ± 18.9 versus 184.6 ± 13.6, p<0.05), and percent predicted maximum workload (61.7 ± 15.9% versus 88.3 ± 21.5%, p<0.05).ConclusionsTetralogy of Fallot patients repaired with a transannular patch can have abnormal pulmonary function testing with poor exercise capacity in addition to chronotropic incompetence and impaired muscular power.

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