Document Detail

Effect of altering pathologic right ventricular loading conditions by percutaneous pulmonary valve implantation on exercise capacity.
MedLine Citation:
PMID:  20185023     Owner:  NLM     Status:  MEDLINE    
The data describing the change in exercise capacity after surgical or interventional management of the patient with right ventricular (RV) outflow tract (OT) dysfunction are conflicting. The pathophysiologic consequences of RVOT interventions and the subsequent change in exercise performance are still poorly understood. We sought to assess the effect of percutaneous pulmonary valve implantation (PPVI) on exercise capacity in (1) patients with predominantly pulmonary stenosis (PS) and (2) in patients with predominantly pulmonary regurgitation (PR). A total of 63 patients with either predominantly PS (n = 37) or PR (n = 26) underwent PPVI. Cardiopulmonary exercise testing and magnetic resonance imaging were performed before and within 1 month after PPVI. On magnetic resonance imaging, the at rest effective biventricular stroke volumes improved in both groups after PPVI (p <0.001), but the ejection fraction improved only in the PS group. In the PS group, exercise capacity (peak oxygen uptake, p <0.001), ventilatory efficiency (p <0.001), and peak oxygen pulse (p <0.001) improved after PPVI. In the PR group, none of these parameters changed after PPVI (p = 0.6, p = 0.12, and p = 0.9, respectively). On multivariate analysis, the reduction in RVOT gradient was the only predictor of improved peak oxygen uptake when assessed in the whole patient group (r(part) = -0.59; p <0.001) or in the PS (r(part) = -0.45; p = 0.002) or PR groups alone (r(part) = -0.45; p = 0.02). In conclusion, acutely after PPVI, exercise capacity improves with the relief of stenosis but not regurgitation. A reduction in the RVOT gradient, even small gradients, was the only independent predictor of improved peak oxygen uptake in both patient groups, irrespective of improved pulmonary valve competence.
Philipp Lurz; Alessandro Giardini; Andrew M Taylor; Johannes Nordmeyer; Vivek Muthurangu; Dolf Odendaal; Bryan Mist; Sachin Khambadkone; Silvia Schievano; Philipp Bonhoeffer; Graham Derrick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-26     Completed Date:  2010-04-06     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  721-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
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MeSH Terms
Cardiac Volume / physiology
Cohort Studies
Exercise Tolerance / physiology*
Heart Valve Prosthesis Implantation*
Magnetic Resonance Imaging
Pulmonary Valve Insufficiency / pathology,  physiopathology*,  therapy*
Pulmonary Valve Stenosis / pathology,  physiopathology*,  therapy*
Treatment Outcome
Ventricular Pressure / physiology
Young Adult
Grant Support
FS/08/012/24454//British Heart Foundation; //British Heart Foundation

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