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Right Ventricular Mass is Associated with Exercise Capacity in Adults with Repaired Tetralogy of Fallot

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Abstract

The relationship between exercise capacity and right ventricular (RV) structure and function in adult repaired tetralogy of Fallot (TOF) is poorly understood. We therefore aimed to examine the relationships between cardiac MRI and cardiopulmonary exercise test variables in adult repaired TOF patients. In particular, we sought to determine the role of RV mass in determining exercise capacity. Eighty-two adult repaired TOF patients (age at evaluation 26 ± 10 years; mean age at repair 2.5 ± 2.8 years; 23.3 ± 7.9 years since repair; 53 males) (including nine patients with tetralogy-type pulmonary atresia with ventricular septal defect) were prospectively recruited to undergo cardiac MRI and cardiopulmonary exercise testing. As expected, these repaired TOF patients had RV dilatation (indexed RV end-diastolic volume: 153 ± 43.9 mL/m2), moderate–severe pulmonary regurgitation (pulmonary regurgitant fraction: 33 ± 14 %) and preserved left (LV ejection fraction: 59 ± 8 %) and RV systolic function (RV ejection fraction: 51 ± 7 %). Exercise capacity was near-normal (peak work: 88 ± 17 % predicted; peak oxygen consumption: 84 ± 17 % predicted). Peak work exhibited a significant positive correlation with RV mass in univariate analysis (r = 0.45, p < 0.001) and (independent of other cardiac MRI variables) in multivariate analyses. For each 10 g higher RV mass, peak work was 8 W higher. Peak work exhibits a significant positive correlation with RV mass, independent of other cardiac MRI variables. RV mass measured on cardiac MRI may provide a novel marker of clinical progress in adult patients with repaired TOF.

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Acknowledgments

Dr Rajesh Puranik is a Medical Foundation Fellow, University of Sydney, Australia. Funding for this project was derived from his fellowship.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Faculty of Medicine, The University of Sydney, Sydney, Australia

    Shamus O’Meagher, Martin Seneviratne, David S. Celermajer & Rajesh Puranik

  2. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia

    Shamus O’Meagher, Peter J. Robinson, David J. Tanous, David S. Celermajer & Rajesh Puranik

  3. Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia

    Michael R. Skilton

  4. Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia

    Phillip A. Munoz

  5. Department of Cardiology, Westmead Children’s Hospital, Sydney, Australia

    Peter J. Robinson

  6. Specialist MRI, Sydney, Australia

    Nathan Malitz

  7. Department of Cardiology, Westmead Hospital, Sydney, Australia

    David J. Tanous

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  1. Shamus O’Meagher
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Correspondence to Shamus O’Meagher.

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O’Meagher, S., Seneviratne, M., Skilton, M.R. et al. Right Ventricular Mass is Associated with Exercise Capacity in Adults with Repaired Tetralogy of Fallot. Pediatr Cardiol 36, 1225–1231 (2015). https://doi.org/10.1007/s00246-015-1150-4

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