alexa Use of Supine Bicycle Stress Echocardiography in Quantitating Right Ventricular Reserve and Exercise Capacity in Adults with Repaired Tetralogy of Fallot | Abstract
ISSN: 2168-9784

Journal of Medical Diagnostic Methods
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Research Article

Use of Supine Bicycle Stress Echocardiography in Quantitating Right Ventricular Reserve and Exercise Capacity in Adults with Repaired Tetralogy of Fallot

Doreen DeFaria Yeh1*, Ameya Kulkarni2, Karen G Ordovas3, Robert W Yeh1, Ami B Bhatt1, Nelson B Schiller3 and Elyse Foster3
1 Massachusetts General Hospital, Boston MA, USA
2 Mid-Altantic Permanente Medical Group, McLean VA, USA
3 University of California San Francisco Medical Center, San Francisco CA, USA
Corresponding Author : Doreen DeFaria Yeh MD
Massachusetts General Hospital
Cardiology Division, 55 Fruit Street
Yawkey 5700, Boston, MA 02114 USA
Tel: +617-643-7024
Fax: +617-643-3963
E-mail: [email protected]
Received December 17, 2013; Accepted January 15, 2014; Published January 25, 2014
Citation: Defaria yeh D, Kulkarni A, Ordovas KG, Yeh RW, Bhatt AB, et al. (2014) Use of Supine Bicycle Stress Echocardiography in Quantitating Right Ventricular Reserve and Exercise Capacity in Adults with Repaired Tetralogy of Fallot. J Med Diagn Meth 3:151. doi:10.4172/2168-9784.1000151
Copyright: © 2014 Defaria yeh D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: This study aimed to examine exercise hemodynamic parameters and exercise capacity in adults with repaired tetralogy of Fallot (rTOF) obtained during supine bicycle echocardiography. Background: In addition to volumetric MRI parameters, exercise capacity in adults with rTOF is often used to determine timing for pulmonic valve replacement (PVR). Supine bicycle echocardiography is useful in measuring right ventricular (RV) hemodynamic parameters and quantifying exercise capacity and myocardial workload. Methods: Supine bicycle echocardiograms performed since 2002 were retrospectively reviewed among 33 adults with rTOF followed at a single adult congenital heart disease center. Echocardiographic and hemodynamic parameters were measured before and at peak exercise. Results: Mean age was 36 ± 12 yrs and severe pulmonic regurgitation (PR) was present in 56%. Mean exercise duration was 15 ± 5 minutes and peak double product was 24,461 ± 6779 units. There was no correlation between resting right ventricular volumetric measurements or tricuspid regurgitant velocity with exercise duration or peak double product. Symptomatic patients in this study had significantly shorter exercise times (17.1 ± 4 vs 12.1 ± 4 minutes, p=0.01) and a trend toward a significantly lower change in the mean pulmonary gradient with exercise (13 ± 8 mmHg vs. 7 ± 2 mmHg, p=0.07). After multivariable linear regression analysis adjusting for age, sex, and severity of PR, a 7 mmHg increase in the ΔPVGp was independently associated with an additional minute of exercise duration (p=0.01). Conclusion: Obtaining exercise right heart hemodynamics with supine bicycle echocardiography is feasible among adult patients with rTOF. Change in transpulmonary valvular gradient with exercise, may reflect RV contractile reserve and provide a physiologic correlate to symptoms and exercise capacity in patients with rTOF

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