Left ventricular outflow tract obstruction and its impact on systolic ventricular function and exercise capacity in adults with a subaortic right ventricle.

Stauber, Annina; Wey, Céline; Greutmann, Matthias; Tobler, Daniel; Wustmann, Kerstin Brigitte; Wahl, Andreas; Valsangiacomo Buechel, Emanuela R; Wilhelm, Matthias; Schwerzmann, Markus (2017). Left ventricular outflow tract obstruction and its impact on systolic ventricular function and exercise capacity in adults with a subaortic right ventricle. International journal of cardiology, 244, pp. 139-142. Elsevier 10.1016/j.ijcard.2017.06.050

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BACKGROUND In biventricular hearts the filling and contractility of one ventricle affects the performance of the other. In this study, we compared right ventricular systolic function and exercise capacity in patients with a subaortic right ventricle (RV) in relation to the presence of a left ventricular outflow tract obstruction (LVOTO). METHODS Retrospective chart review of adults with congenitally corrected transposition of the great arteries (ccTGA) or with a previous atrial switch procedure for complete TGA (D-TGA). A LVOTO was defined by a peak instantaneous systolic gradient>20mmHg. Right and left ventricular ejection fraction (EF) were measured by cardiac magnetic resonance imaging (CMR), and exercise capacity as the predicted peak oxygen consumption (peak VO2) on a cycle ergometer. RESULTS We identified 79 clinically stable adults (age 33±10years, 70% male). Nine patients (11%) had cc-TGA and 70 patients had (89%) D-TGA. Thirteen patients (16%) had a LVOTO with a mean peak instantaneous systolic gradient of 43±22mmHg. Patients with a LVOTO had higher left (68±7% vs. 60±9%, p=0.01) and right ventricular EF (52±8 vs. 46±9%, p=0.05) by CMR compared to patients without LVOTO. In a multivariate regression analysis with left ventricular EF and LVOTO as predictors, only left ventricular EF was independently associated with right ventricular EF (correlation coefficient 0.41, p<0.01). The presence of a LVOTO was not associated with improved exercise capacity. CONCLUSIONS In adults with a subaortic RV, a pressure loaded subpulmonary left ventricle has a beneficial effect on systemic right ventricular EF.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Stauber, Annina; Wustmann, Kerstin Brigitte; Wahl, Andreas; Wilhelm, Matthias and Schwerzmann, Markus

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0167-5273

Publisher:

Elsevier

Language:

English

Submitter:

Markus Schwerzmann

Date Deposited:

27 Nov 2017 15:58

Last Modified:

27 Nov 2017 15:58

Publisher DOI:

10.1016/j.ijcard.2017.06.050

PubMed ID:

28629628

Uncontrolled Keywords:

Exercise capacity Transposition of great arteries Ventricular function Ventricular outflow obstruction

BORIS DOI:

10.7892/boris.106642

URI:

https://boris.unibe.ch/id/eprint/106642

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