Right heart characteristics and exercise parameters in adults with Ebstein anomaly: New perspectives from cardiac magnetic resonance imaging studies

Daniel Tobler, Sergey Yalonetsky, Andrew M. Crean, John T. Granton, Luke Burchill, Candice K. Silversides, Rachel M. Wald

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: The utility of cardiac magnetic resonance imaging (CMR) for assessment of adults with Ebstein anomaly is not well-defined. We sought to evaluate CMR characteristics in this population and to relate these to exercise parameters. Methods: We analyzed CMR studies in adults with unrepaired Ebstein anomaly for measures of severity of Ebstein disease, including atrialized, functional and total right ventricular (RV) volumes, ejection fraction (EF) and severity index (area of atrialized RV + right atrium/functional RV + left ventricle + left atrium). We related these CMR values to cardiopulmonary exercise test measurements. Results: Twenty-seven adults (mean age 41 ± 14 years, 70% female) were included. Functional RV end-diastolic volume (EDV) was 150 ± 68 mL/m2 and atrialized RVEDV was 25 ± 24 mL/m2. In 17 patients (63%), the functional RVEDV was enlarged (> 114 mL/m2). Percent predicted peak VO2 for the population was 65 ± 20%. On univariable analysis, peak VO2 was inversely related to atrialized RVEDV (p = 0.011), total RVEDV (p = 0.041), functional RVEDV/left ventricular EDV ratio (p = 0.015) and magnitude of tricuspid valve displacement (p = 0.031). In the multivariate model, the only CMR factor to relate to peak VO2 was atrialized RVEDV (p = 0.011, β = - 0.48). No significant correlations were found between CMR measures and heart rate response or ventilatory response to exercise. Conclusion: In adults with unrepaired Ebstein anomaly, atrialized RV volume was independently related to aerobic capacity. The volume of the atrialized RV is a novel CMR measure which may express severity of disease. Further research is needed to evaluate the prognostic relevance of this exploratory work.

Original languageEnglish (US)
Pages (from-to)146-150
Number of pages5
JournalInternational Journal of Cardiology
Volume165
Issue number1
DOIs
StatePublished - Apr 30 2013
Externally publishedYes

Fingerprint

Ebstein Anomaly
Magnetic Resonance Imaging
Exercise
Stroke Volume
Heart Atria
Tricuspid Valve
Population Characteristics
Exercise Test
Heart Ventricles
Heart Rate

Keywords

  • Adult congenital heart disease
  • Ebstein anomaly
  • Exercise capacity
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Right heart characteristics and exercise parameters in adults with Ebstein anomaly : New perspectives from cardiac magnetic resonance imaging studies. / Tobler, Daniel; Yalonetsky, Sergey; Crean, Andrew M.; Granton, John T.; Burchill, Luke; Silversides, Candice K.; Wald, Rachel M.

In: International Journal of Cardiology, Vol. 165, No. 1, 30.04.2013, p. 146-150.

Research output: Contribution to journalArticle

Tobler, Daniel ; Yalonetsky, Sergey ; Crean, Andrew M. ; Granton, John T. ; Burchill, Luke ; Silversides, Candice K. ; Wald, Rachel M. / Right heart characteristics and exercise parameters in adults with Ebstein anomaly : New perspectives from cardiac magnetic resonance imaging studies. In: International Journal of Cardiology. 2013 ; Vol. 165, No. 1. pp. 146-150.
@article{00b7884a052146ce9d0d808959a0e334,
title = "Right heart characteristics and exercise parameters in adults with Ebstein anomaly: New perspectives from cardiac magnetic resonance imaging studies",
abstract = "Background: The utility of cardiac magnetic resonance imaging (CMR) for assessment of adults with Ebstein anomaly is not well-defined. We sought to evaluate CMR characteristics in this population and to relate these to exercise parameters. Methods: We analyzed CMR studies in adults with unrepaired Ebstein anomaly for measures of severity of Ebstein disease, including atrialized, functional and total right ventricular (RV) volumes, ejection fraction (EF) and severity index (area of atrialized RV + right atrium/functional RV + left ventricle + left atrium). We related these CMR values to cardiopulmonary exercise test measurements. Results: Twenty-seven adults (mean age 41 ± 14 years, 70{\%} female) were included. Functional RV end-diastolic volume (EDV) was 150 ± 68 mL/m2 and atrialized RVEDV was 25 ± 24 mL/m2. In 17 patients (63{\%}), the functional RVEDV was enlarged (> 114 mL/m2). Percent predicted peak VO2 for the population was 65 ± 20{\%}. On univariable analysis, peak VO2 was inversely related to atrialized RVEDV (p = 0.011), total RVEDV (p = 0.041), functional RVEDV/left ventricular EDV ratio (p = 0.015) and magnitude of tricuspid valve displacement (p = 0.031). In the multivariate model, the only CMR factor to relate to peak VO2 was atrialized RVEDV (p = 0.011, β = - 0.48). No significant correlations were found between CMR measures and heart rate response or ventilatory response to exercise. Conclusion: In adults with unrepaired Ebstein anomaly, atrialized RV volume was independently related to aerobic capacity. The volume of the atrialized RV is a novel CMR measure which may express severity of disease. Further research is needed to evaluate the prognostic relevance of this exploratory work.",
keywords = "Adult congenital heart disease, Ebstein anomaly, Exercise capacity, Magnetic resonance imaging",
author = "Daniel Tobler and Sergey Yalonetsky and Crean, {Andrew M.} and Granton, {John T.} and Luke Burchill and Silversides, {Candice K.} and Wald, {Rachel M.}",
year = "2013",
month = "4",
day = "30",
doi = "10.1016/j.ijcard.2011.08.004",
language = "English (US)",
volume = "165",
pages = "146--150",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Right heart characteristics and exercise parameters in adults with Ebstein anomaly

T2 - New perspectives from cardiac magnetic resonance imaging studies

AU - Tobler, Daniel

AU - Yalonetsky, Sergey

AU - Crean, Andrew M.

AU - Granton, John T.

AU - Burchill, Luke

AU - Silversides, Candice K.

AU - Wald, Rachel M.

PY - 2013/4/30

Y1 - 2013/4/30

N2 - Background: The utility of cardiac magnetic resonance imaging (CMR) for assessment of adults with Ebstein anomaly is not well-defined. We sought to evaluate CMR characteristics in this population and to relate these to exercise parameters. Methods: We analyzed CMR studies in adults with unrepaired Ebstein anomaly for measures of severity of Ebstein disease, including atrialized, functional and total right ventricular (RV) volumes, ejection fraction (EF) and severity index (area of atrialized RV + right atrium/functional RV + left ventricle + left atrium). We related these CMR values to cardiopulmonary exercise test measurements. Results: Twenty-seven adults (mean age 41 ± 14 years, 70% female) were included. Functional RV end-diastolic volume (EDV) was 150 ± 68 mL/m2 and atrialized RVEDV was 25 ± 24 mL/m2. In 17 patients (63%), the functional RVEDV was enlarged (> 114 mL/m2). Percent predicted peak VO2 for the population was 65 ± 20%. On univariable analysis, peak VO2 was inversely related to atrialized RVEDV (p = 0.011), total RVEDV (p = 0.041), functional RVEDV/left ventricular EDV ratio (p = 0.015) and magnitude of tricuspid valve displacement (p = 0.031). In the multivariate model, the only CMR factor to relate to peak VO2 was atrialized RVEDV (p = 0.011, β = - 0.48). No significant correlations were found between CMR measures and heart rate response or ventilatory response to exercise. Conclusion: In adults with unrepaired Ebstein anomaly, atrialized RV volume was independently related to aerobic capacity. The volume of the atrialized RV is a novel CMR measure which may express severity of disease. Further research is needed to evaluate the prognostic relevance of this exploratory work.

AB - Background: The utility of cardiac magnetic resonance imaging (CMR) for assessment of adults with Ebstein anomaly is not well-defined. We sought to evaluate CMR characteristics in this population and to relate these to exercise parameters. Methods: We analyzed CMR studies in adults with unrepaired Ebstein anomaly for measures of severity of Ebstein disease, including atrialized, functional and total right ventricular (RV) volumes, ejection fraction (EF) and severity index (area of atrialized RV + right atrium/functional RV + left ventricle + left atrium). We related these CMR values to cardiopulmonary exercise test measurements. Results: Twenty-seven adults (mean age 41 ± 14 years, 70% female) were included. Functional RV end-diastolic volume (EDV) was 150 ± 68 mL/m2 and atrialized RVEDV was 25 ± 24 mL/m2. In 17 patients (63%), the functional RVEDV was enlarged (> 114 mL/m2). Percent predicted peak VO2 for the population was 65 ± 20%. On univariable analysis, peak VO2 was inversely related to atrialized RVEDV (p = 0.011), total RVEDV (p = 0.041), functional RVEDV/left ventricular EDV ratio (p = 0.015) and magnitude of tricuspid valve displacement (p = 0.031). In the multivariate model, the only CMR factor to relate to peak VO2 was atrialized RVEDV (p = 0.011, β = - 0.48). No significant correlations were found between CMR measures and heart rate response or ventilatory response to exercise. Conclusion: In adults with unrepaired Ebstein anomaly, atrialized RV volume was independently related to aerobic capacity. The volume of the atrialized RV is a novel CMR measure which may express severity of disease. Further research is needed to evaluate the prognostic relevance of this exploratory work.

KW - Adult congenital heart disease

KW - Ebstein anomaly

KW - Exercise capacity

KW - Magnetic resonance imaging

UR - http://www.scopus.com/inward/record.url?scp=84876146480&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876146480&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2011.08.004

DO - 10.1016/j.ijcard.2011.08.004

M3 - Article

C2 - 21872945

AN - SCOPUS:84876146480

VL - 165

SP - 146

EP - 150

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 1

ER -