Exercise intolerance in patients with congenitally corrected transposition of the great arteries relates to right ventricular filling pressures

Edgar L W Tay, Alexandra Frogoudaki, Ryo Inuzuka, Georgios Giannakoulas, Matina Prapa, Wei Li, George Pantely, Konstantinos Dimopoulos, Michael A. Gatzoulis

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Patients with congenitally corrected transposition of the great arteries (ccTGA) have significantly reduced exercise tolerance. Progressive right ventricular (RV) dysfunction with tricuspid regurgitation (TR) and other haemodynamic lesions are common among them. We hypothesised that interaction of these factors may result in increased systemic RV filling pressure, which in turn impact on exercise capacity. Methods: Patients with ccTGA in functional class I or II, able to perform treadmill exercise and without resting cyanosis were enrolled. All patients underwent cardiopulmonary exercise testing and transthoracic echocardiographic examination. RV filling pressure was estimated using tissue Doppler imaging (TDI) techniques by measuring early annular diastolic velocity (Ea) and the ratio of the transtricuspid inflow to the early annular diastolic velocity (E/Ea). Results: A total of 27 patients (mean age 41 years, 48% female) were assessed, the majority (63%) asymptomatic. Many patients had coexistent haemodynamic lesions including shunts, pulmonary stenosis, TR and systemic ventricular dysfunction. Average percentage predicted peak oxygen consumption, VE/VCO 2 slope and heart rate reserve were abnormal in this population. Patients with moderately/severely impaired exercise capacity (≤ 60% predicted peak VO 2) had significantly higher E/Ea ratios compared to those with normal/mildly impaired exercise capacity (septal E/Ea = 17.1 ± 9.7 vs 8.8 ± 1.6 and lateral E/Ea = 11.5 ± 5.8 vs 6.6 ± 1.3, p = 0.007 and 0.01 respectively). Conclusion: Reduced exercise capacity is common in adults with ccTGA even among asymptomatic patients and relates to increased RV filling pressures assessed by TDI. This index could potentially be used to optimize therapy or prognosticate adverse events in ccTGA patients.

Original languageEnglish (US)
Pages (from-to)219-223
Number of pages5
JournalInternational Journal of Cardiology
Volume147
Issue number2
DOIs
StatePublished - Mar 3 2011
Externally publishedYes

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Ventricular Pressure
Exercise
Tricuspid Valve Insufficiency
Hemodynamics
Right Ventricular Dysfunction
Ventricular Dysfunction
Cyanosis
Pulmonary Valve Stenosis
Exercise Tolerance
Congenitally corrected transposition of the great arteries
Oxygen Consumption
Heart Rate
Population

Keywords

  • Cardiopulmonary exercise testing
  • Congenitally corrected transposition of the great arteries
  • Tissue Doppler imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Exercise intolerance in patients with congenitally corrected transposition of the great arteries relates to right ventricular filling pressures. / Tay, Edgar L W; Frogoudaki, Alexandra; Inuzuka, Ryo; Giannakoulas, Georgios; Prapa, Matina; Li, Wei; Pantely, George; Dimopoulos, Konstantinos; Gatzoulis, Michael A.

In: International Journal of Cardiology, Vol. 147, No. 2, 03.03.2011, p. 219-223.

Research output: Contribution to journalArticle

Tay, ELW, Frogoudaki, A, Inuzuka, R, Giannakoulas, G, Prapa, M, Li, W, Pantely, G, Dimopoulos, K & Gatzoulis, MA 2011, 'Exercise intolerance in patients with congenitally corrected transposition of the great arteries relates to right ventricular filling pressures', International Journal of Cardiology, vol. 147, no. 2, pp. 219-223. https://doi.org/10.1016/j.ijcard.2009.08.038
Tay, Edgar L W ; Frogoudaki, Alexandra ; Inuzuka, Ryo ; Giannakoulas, Georgios ; Prapa, Matina ; Li, Wei ; Pantely, George ; Dimopoulos, Konstantinos ; Gatzoulis, Michael A. / Exercise intolerance in patients with congenitally corrected transposition of the great arteries relates to right ventricular filling pressures. In: International Journal of Cardiology. 2011 ; Vol. 147, No. 2. pp. 219-223.
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abstract = "Background: Patients with congenitally corrected transposition of the great arteries (ccTGA) have significantly reduced exercise tolerance. Progressive right ventricular (RV) dysfunction with tricuspid regurgitation (TR) and other haemodynamic lesions are common among them. We hypothesised that interaction of these factors may result in increased systemic RV filling pressure, which in turn impact on exercise capacity. Methods: Patients with ccTGA in functional class I or II, able to perform treadmill exercise and without resting cyanosis were enrolled. All patients underwent cardiopulmonary exercise testing and transthoracic echocardiographic examination. RV filling pressure was estimated using tissue Doppler imaging (TDI) techniques by measuring early annular diastolic velocity (Ea) and the ratio of the transtricuspid inflow to the early annular diastolic velocity (E/Ea). Results: A total of 27 patients (mean age 41 years, 48{\%} female) were assessed, the majority (63{\%}) asymptomatic. Many patients had coexistent haemodynamic lesions including shunts, pulmonary stenosis, TR and systemic ventricular dysfunction. Average percentage predicted peak oxygen consumption, VE/VCO 2 slope and heart rate reserve were abnormal in this population. Patients with moderately/severely impaired exercise capacity (≤ 60{\%} predicted peak VO 2) had significantly higher E/Ea ratios compared to those with normal/mildly impaired exercise capacity (septal E/Ea = 17.1 ± 9.7 vs 8.8 ± 1.6 and lateral E/Ea = 11.5 ± 5.8 vs 6.6 ± 1.3, p = 0.007 and 0.01 respectively). Conclusion: Reduced exercise capacity is common in adults with ccTGA even among asymptomatic patients and relates to increased RV filling pressures assessed by TDI. This index could potentially be used to optimize therapy or prognosticate adverse events in ccTGA patients.",
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AU - Tay, Edgar L W

AU - Frogoudaki, Alexandra

AU - Inuzuka, Ryo

AU - Giannakoulas, Georgios

AU - Prapa, Matina

AU - Li, Wei

AU - Pantely, George

AU - Dimopoulos, Konstantinos

AU - Gatzoulis, Michael A.

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N2 - Background: Patients with congenitally corrected transposition of the great arteries (ccTGA) have significantly reduced exercise tolerance. Progressive right ventricular (RV) dysfunction with tricuspid regurgitation (TR) and other haemodynamic lesions are common among them. We hypothesised that interaction of these factors may result in increased systemic RV filling pressure, which in turn impact on exercise capacity. Methods: Patients with ccTGA in functional class I or II, able to perform treadmill exercise and without resting cyanosis were enrolled. All patients underwent cardiopulmonary exercise testing and transthoracic echocardiographic examination. RV filling pressure was estimated using tissue Doppler imaging (TDI) techniques by measuring early annular diastolic velocity (Ea) and the ratio of the transtricuspid inflow to the early annular diastolic velocity (E/Ea). Results: A total of 27 patients (mean age 41 years, 48% female) were assessed, the majority (63%) asymptomatic. Many patients had coexistent haemodynamic lesions including shunts, pulmonary stenosis, TR and systemic ventricular dysfunction. Average percentage predicted peak oxygen consumption, VE/VCO 2 slope and heart rate reserve were abnormal in this population. Patients with moderately/severely impaired exercise capacity (≤ 60% predicted peak VO 2) had significantly higher E/Ea ratios compared to those with normal/mildly impaired exercise capacity (septal E/Ea = 17.1 ± 9.7 vs 8.8 ± 1.6 and lateral E/Ea = 11.5 ± 5.8 vs 6.6 ± 1.3, p = 0.007 and 0.01 respectively). Conclusion: Reduced exercise capacity is common in adults with ccTGA even among asymptomatic patients and relates to increased RV filling pressures assessed by TDI. This index could potentially be used to optimize therapy or prognosticate adverse events in ccTGA patients.

AB - Background: Patients with congenitally corrected transposition of the great arteries (ccTGA) have significantly reduced exercise tolerance. Progressive right ventricular (RV) dysfunction with tricuspid regurgitation (TR) and other haemodynamic lesions are common among them. We hypothesised that interaction of these factors may result in increased systemic RV filling pressure, which in turn impact on exercise capacity. Methods: Patients with ccTGA in functional class I or II, able to perform treadmill exercise and without resting cyanosis were enrolled. All patients underwent cardiopulmonary exercise testing and transthoracic echocardiographic examination. RV filling pressure was estimated using tissue Doppler imaging (TDI) techniques by measuring early annular diastolic velocity (Ea) and the ratio of the transtricuspid inflow to the early annular diastolic velocity (E/Ea). Results: A total of 27 patients (mean age 41 years, 48% female) were assessed, the majority (63%) asymptomatic. Many patients had coexistent haemodynamic lesions including shunts, pulmonary stenosis, TR and systemic ventricular dysfunction. Average percentage predicted peak oxygen consumption, VE/VCO 2 slope and heart rate reserve were abnormal in this population. Patients with moderately/severely impaired exercise capacity (≤ 60% predicted peak VO 2) had significantly higher E/Ea ratios compared to those with normal/mildly impaired exercise capacity (septal E/Ea = 17.1 ± 9.7 vs 8.8 ± 1.6 and lateral E/Ea = 11.5 ± 5.8 vs 6.6 ± 1.3, p = 0.007 and 0.01 respectively). Conclusion: Reduced exercise capacity is common in adults with ccTGA even among asymptomatic patients and relates to increased RV filling pressures assessed by TDI. This index could potentially be used to optimize therapy or prognosticate adverse events in ccTGA patients.

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