Article Text

other Versions

PDF
Original article
Functional and haemodynamic assessment of mild-to-moderate pulmonary valve stenosis at rest and during exercise
  1. Pieter De Meester1,
  2. Roselien Buys2,
  3. Alexander Van De Bruaene1,
  4. Charlien Gabriels1,
  5. Jens-Uwe Voigt1,
  6. Luc Vanhees2,
  7. Paul Herijgers3,
  8. Els Troost1,
  9. Werner Budts1
  1. 1Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
  2. 2Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
  3. 3Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
  1. Correspondence to Werner Budts, Department of Cardiology, University Hospitals Leuven, Leuven, Belgium, Herestraat 49, Leuven B-3000, Belgium; werner.budts{at}uzleuven.be

Abstract

Objective In adult patients with mild-to-moderate pulmonary valve (PV) stenosis, exercise capacity and haemodynamics have not been extensively studied, although regular exercise is recommended. Therefore, we aimed to assess exercise capacity to study the increase in PV gradient during exercise and to evaluate the impact of this increased pressure load on the RV.

Methods Nineteen patients (8 female; 29±6.4 years) with isolated mild-to-moderate PV stenosis and no prior cardiac interventions were consecutively enrolled from the outpatient clinic of adult congenital heart disease. All patients underwent cardiopulmonary exercise testing, transthoracic echocardiography and bicycle stress echocardiography. Results for exercise testing were compared with age-matched and gender-matched control patients.

Results In the studied population, resting heart rate (89±11 vs 75±14 bpm; p=0.001), peak power (199±66 vs 263±68 W; p=0.006); peak VO2 (31.2±9.9 vs 39±7.4 mL/kg/min; p=0.011); oxygen uptake efficiency slope (2430±913 vs 3292±943(mL/min)/(L/min); p=0.007) and VE/VCO2 slope (26.8±5.2 vs 22.6±4.3; p=0.01) differed significantly from controls. A linear increase of peak PV gradient with increasing flow was observed in the pooled dataset (Pearson's R=0.947; p<0.0001) and slopes identical as for control patients were obtained for the oxygen pulse–workload relationship. Right heart morphology and function were preserved in the studied patients.

Conclusions Patients with mild-to-moderate PV stenosis have decreased exercise capacity. A linear increase in PV gradient with flow suggests a fixed valve area throughout the exercise. Although systolic RV pressure load increases during exercise, good ventricular performance was observed without signs of functional or morphological changes of the right heart.

Clinical trial number: NCT01444222

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles