Korean Circ J.  2017 Mar;47(2):254-262. 10.4070/kcj.2016.0226.

Short-Term Change of Exercise Capacity in Patients with Pulmonary Valve Replacement after Tetralogy of Fallot Repair

• Hwang TW
• Kim SO
• Kim MS
• Jang SI
• Kim SH
• Lee SY
• Choi EY
• Park SJ
• Kwon HW
• Lim HB

• KMID: 2377467
• DOI: http://doi.org/10.4070/kcj.2016.0226

Abstract

BACKGROUND AND OBJECTIVES
The aim of this study was to investigate the effect of pulmonary valve replacement (PVR) on exercise capacity and determine cardiopulmonary exercise (CPEX) parameters associated with improvement in right ventricle (RV) function.
SUBJECTS AND METHODS
We retrospectively analyzed CPEX and magnetic resonance imaging parameters in a total of 245 patients who underwent PVR from January 1998 to October 2015. In addition, we analyzed the characteristics of the patients who showed improved exercise capacity after PVR.
RESULTS
Twenty-eight patients met the inclusion criteria for the study. CPEX parameters after PVR showed no significant changes in all patients. However, baseline predicted peak oxygen uptake (VO2(peak)) (%) value was significantly lower in patients with significant improvement in exercise capacity after PVR, as compared to patients who showed decreased exercise capacity after PVR (60.83±10.28 vs. 75.81±13.83) (p=0.003). In addition, patients with improved exercise capacity showed a positive correlation between the change of right ventricular ejection fraction (RVEF) (%) and the change of anaerobic threshold (r=0.733, p=0.007); whereas, patients with decreased exercise capacity showed a negative correlation between the change of RVEF (%) and the change of predicted VO2(peak) (%) (r=−0.575, p=0.020).
CONCLUSION
The importance of predicted VO2(peak) (%) in evaluating exercise capacity differentiated from other CPEX variables. The change of anaerobic threshold and predicted VO2(peak) (%) might be a useful predictor of the change in RV function after PVR.

Keyword

Cardiopulmonary exercise test; Pulmonary valve replacement; Tetralogy of Fallot

MeSH Terms

Anaerobic Threshold
Exercise Test
Heart Ventricles
Humans
Magnetic Resonance Imaging
Oxygen
Pulmonary Valve*
Retrospective Studies
Stroke Volume
Tetralogy of Fallot*
Oxygen

Figure

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  Fig. 1 The change of exercise capacities in group 1 after PVR. Group 1: post PVR VO2peak were increased, as compared to pre PVR VO2peak. The mean VO2at improved from 24.15 to 25.38 mL/kg/min (p=0.051), the mean VO2peak from 28.53 to 33.09 mL/kg/min (p=0.001). PVR: pulmonary valve replacement, VO2at: anaerobic threshold, VO2peak: peak oxygen uptake.

• 

  Fig. 2 The change of exercise capacities in group 2 after PVR Group 2: post PVR VO2peak were decreased, as compared to pre PVR VO2peak. The mean VO2at decreased from 23.58 to 20.83 mL/kg/min (p=0.030), the mean VO2peak from 31.24 to 27.39 mL/kg/min (p<0.001). PVR: pulmonary valve replacement, VO2at: anaerobic threshold, VO2peak: peak oxygen uptake.

• 

  Fig. 3 The comparison of pre PVR predicted VO2peak (%) between the two groups. Group 1: post PVR VO2peak were increased, as compared to pre PVR VO2peak. Group 2: post PVR VO2peak were decreased, as compared to pre PVR VO2peak. Pre PVR Predicted VO2peak (%) value was significantly lower in patients belonging to group 1 (60.83±10.28) than group 2 (75.81±13.83) (p=0.003). PVR: pulmonary valve replacement, PredVO2peak (%): percentage of predicted VO2peak.

• 

  Fig. 4 The comparison of Δpredicted VO2peak (%) between the two groups. Group 1: post PVR VO2peak were increased, as compared to pre PVR VO2peak. Group 2: post PVR VO2peak were decreased, as compared to pre PVR VO2peak. The changes of predicted VO2peak (%) in patients belonging to group 1 were significantly higher than group 2 (10.17±7.63 vs. -10.56±8.03, p<0.001). PVR: pulmonary valve replacement, PredVO2peak (%): percentage of predicted VO2peak.

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  Fig. 5 The correlation between ΔRVEF (%) and ΔVO2at in patients belonging to group 1. Group 1: post PVR VO2peak were increased, as compared to pre PVR VO2peak. The change of RVEF (%) was positively correlated with the change of VO2at (r=0.733, p=0.007) in patients who showed increased VO2peak after PVR. RVEF: right ventricular ejection fraction. VO2at: anaerobic threshold, VO2peak: peak oxygen uptake, PVR: pulmonary valve replacement.

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  Fig. 6 The correlation between ΔRVEF (%) and Δpredicted VO2peak (%) in patients belonging to group 2. Group 2: post PVR VO2peak of patients were decreased, as compared to pre PVR VO2peak. The change of RVEF (%) was negatively correlated with the change of predicted VO2peak (%) (r=-0.575, p=0.020) in patients who showed decreased VO2peak after PVR. PVR: pulmonary valve replacement, RVEF: right ventricular ejection fraction. VO2peak: peak oxygen uptake. PredVO2peak (%): percentage of predicted VO2peak.

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