| Impact of reduction in right ventricular pressure and/or volume overload by percutaneous pulmonary valve implantation on biventricular response to exercise: an exercise stress real-time CMR study. | |
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MedLine Citation:
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PMID: 22798559 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: To assess the impact of relief of pulmonary stenosis (PS) and pulmonary regurgitation (PR) by percutaneous pulmonary valve implantation (PPVI) on biventricular function during exercise stress. METHODS AND RESULTS: Seventeen patients, who underwent PPVI for PS or PR, were included. Magnetic resonance imaging was performed at rest and during supine exercise stress pre- and within 1-month post-PPVI, using a radial k - t SENSE real-time sequence. In patients with PS (n = 9), there was no reserve in right ventricular (RV) ejection fraction (EF) in response to exercise prior to PPVI (48.2 ± 12.1% at rest vs. 48.4 ± 14.8% during exercise, P = 0.87). Post-PPVI, reserve in RVEF in response to exercise was re-established (53.4 ± 15.0% at rest vs. 59.6 ± 17.3% during exercise, P = 0.003) with improvement in left ventricular stroke volume (LVSV) (45.4 ± 6.2 mL/m(2) at rest vs. 52.8 ± 8.8 mL/m(2) during exercise, P = 0.001). In patients with PR prior to PPVI (n = 8), LVSV during exercise increased (43.0 ± 8.5 vs. 54.3 ± 6.6 mL/m(2), P < 0.001) due to reduction in PR fraction during exercise (29.2 ± 5.2 vs. 13.6 ± 6.1%, P < 0.001). After PPVI, LVSV increased from rest to exercise (48.4 ± 8.8 vs. 57.2 ± 8.1 mL/m(2), P < 0.001) due to improved RVEF (45.5 ± 8.3 vs. 50.4 ± 6.9%, P = 0.001). There was a significantly higher increase in LVSV at exercise from pre- to post-PPVI in PS patients than in PR patients (ΔLVSV 8.2 ± 4.1 vs. Δ2.9 ± 4.1 mL/m(2), P = 0.01). The reduction in the RV outflow tract gradient correlated significantly with the improvement in LVSV during exercise (r = -0.73, P < 0.001). CONCLUSION: Percutaneous pulmonary valve implantation in patients with PS leads to restoration of reserve in RVEF during exercise stress. In patients with PR, SV augmentation improves only mildly post-PPVI. Improvement in SV augmentation during exercise stress after PPVI is dependent mainly on afterload reduction. |
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Authors:
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Philipp Lurz; Vivek Muthurangu; Pia K Schuler; Alessandro Giardini; Silvia Schievano; Johannes Nordmeyer; Sachin Khambadkone; Claudio Cappeli; Graham Derrick; Philipp Bonhoeffer; Andrew M Taylor |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2012-07-12 |
Journal Detail:
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Title: European heart journal Volume: 33 ISSN: 1522-9645 ISO Abbreviation: Eur. Heart J. Publication Date: 2012 Oct |
Date Detail:
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Created Date: 2012-10-02 Completed Date: 2013-02-19 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 2434-41 Citation Subset: IM |
Affiliation:
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Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, London, UK. philipp.lurz@gmx.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Cardiac Catheterization / methods* Cardiac-Gated Imaging Techniques / methods Child Exercise / physiology* Exercise Test Female Heart Valve Prosthesis Implantation / methods* Humans Magnetic Resonance Angiography / methods Male Prospective Studies Pulmonary Valve / physiology Pulmonary Valve Insufficiency / physiopathology, surgery* Pulmonary Valve Stenosis / physiopathology, surgery* Stroke Volume / physiology Ventricular Function, Right / physiology Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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FS/08/012/24454//British Heart Foundation |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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