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Echocardiographic assessment of diastolic biventricular properties in patients operated for severe pulmonary regurgitation and association with exercise capacity.
MedLine Citation:
PMID:  22315361     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIMS: We aimed to assess the impact of surgical pulmonary valve replacement (PVR) for severe pulmonary regurgitation (PR) on biventricular function and its effect on exercise capacity. METHODS AND RESULTS: Seventy-three patients (mean age 23.6 ± 11.5 years, 47 females) underwent surgical PVR for PR. Echocardiogram and magnetic resonance imaging to assess ventricular size and function, and a cardiopulmonary exercise test were performed before, and 1-year post-surgery. Median New York Heart Association class improved from 2 to 1 but peak oxygen uptake (VO(2)) did not change. Left ventricular (LV) cardiac output increased from 3.2 ± 0.9 to 3.5 ± 0.7 L/min (P = 0.003). However, this was not associated with increased trans-mitral velocities (▵E = -0.13, P = 0.004; ▵A = 0.03, P = 0.395), or increased heart rate (-0.002%, P = 0.993). Trans-tricuspid rapid right ventricular (RV) filling increased significantly, whereas early diastolic myocardial velocity in RV wall decreased (E velocity: 0.57 ± 0.14-0.65 ± 0.21, P = 0.034; and E/e' from 6.7 ± 1.9 to 14.8 ± 7.0, P < 0.0001). RV and LV late diastolic velocities and their ratio to early velocities (A, a', E/A, and e'/a') correlated with pre- and/or post-PVR peak VO(2). No correlations were found between indexes of systolic function and peak VO(2), either before or after surgery. Doppler evidence of restrictive RV physiology resolved after elimination of PR. CONCLUSION: Surgical PVR for PR improves RV filling and increases left ventricular stroke volume, however, this could not be demonstrated by conventional Doppler echocardiography. Diastolic ventricular function was associated with exercise capacity. Because of its load dependency, E/e' ratio failed in assessing diastolic function. Pre-systolic flow in pulmonary trunk in presence of severe PR does not determine intrinsic myocardial stiffness.
Authors:
Alessandra Frigiola; Alessandro Giardini; Andrew Taylor; Victor Tsang; Graham Derrick; Sachin Khambadkone; Fiona Walker; Shay Cullen; Philipp Bonhoeffer; Jan Marek
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-7
Journal Detail:
Title:  European heart journal cardiovascular Imaging     Volume:  -     ISSN:  2047-2412     ISO Abbreviation:  Eur Heart J Cardiovasc Imaging     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101573788     Medline TA:  Eur Heart J Cardiovasc Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
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