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Congenital heart disease
Original research
Predictors of low exercise cardiac output in patients with severe pulmonic regurgitation
  1. Clément Karsenty1,2,
  2. Diala Khraiche3,
  3. Jean Philippe Jais4,5,
  4. Francesca Raimondi3,6,
  5. Magalie Ladouceur1,7,
  6. Victor Waldmann1,
  7. Gilles Soulat7,8,
  8. Florence Pontnau1,
  9. Damien Bonnet3,6,
  10. Laurence Iserin1,
  11. Antoine Legendre1,3
  1. 1 Unité Médico-Chirurgicale de Cardiologie Congénitale Adulte, Hopital Europeen Georges Pompidou, Paris, Île-de-France, France
  2. 2 Pediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Toulouse, Midi-Pyrénées, France
  3. 3 Pediatric Cardiology Unit 'centre de référence des malformations cardiaques congénitales complexes—M3C', Necker-Enfants Malades Hospitals, Paris, Île-de-France, France
  4. 4 Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, Île-de-France, France
  5. 5 Biostatistics Unit, Necker-Enfants Malades Hospitals, Paris, Île-de-France, France
  6. 6 Université de Paris, Paris, France
  7. 7 INSERM U970, PARCC, Université Paris 5 Descartes, Paris, Île-de-France, France
  8. 8 Department of Radiology, Hospital European George Pompidou, Paris, Île-de-France, France
  1. Correspondence to Dr Antoine Legendre, Pediatric Cardiology Unit “centre de référence des malformations cardiaques congénitales complexes - M3C”, Necker-Enfants Malades Hospitals, Paris 75743, France; antoine.legendre{at}aphp.fr

Abstract

Background and objectives Chronic pulmonic regurgitation (PR) following repair of congenital heart disease (CHD) impairs right ventricular function that impacts peak exercise cardiac index (pCI). We aimed to estimate in a non-invasive way pCI and peak oxygen consumption (pVO2) and to evaluate predictors of low pCI in patients with significant residual pulmonic regurgitation after CHD repair.

Method We included 82 patients (median age 19 years (range 10–54 years)) with residual pulmonic regurgitation fraction >40%. All underwent cardiac MRI and cardiopulmonary testing with measurement of pCI by thoracic impedancemetry. Low pCI was defined <7 L/min/m2.

Results Low pCI was found in 18/82 patients. Peak indexed stroke volume (pSVi) tended to compensate chronotropic insufficiency only in patients with normal pCI (r=−0.31, p=0.01). Below 20 years of age, only 5/45 patients had low pCI but near-normal (≥6.5 L/min/m2). pVO2 (mL/kg/min) was correlated with pCI (r=0.58, p=0.0002) only in patients aged >20 years. Left ventricular stroke volume in MRI correlated with pSVi only in the group of patients with low pCI (r=0.54, p=0.02). No MRI measurements predicted low pCI. In multivariable analysis, only age predicted a low pCI (OR=1.082, 95% CI 1.035 to 1.131, p=0.001) with continuous increase of risk with age.

Conclusions In patients with severe PR, pVO2 is a partial reflection of pCI. Risk of low pCI increases with age. No resting MRI measurement predicts low haemodynamic response to exercise. Probably more suitable to detect ventricular dysfunction, pCI measurement could be an additional parameter to take into account when considering pulmonic valve replacement.

  • congenital heart disease
  • pulmonic valve disease
  • congenital heart disease surgery

https://doi.org/10.1136/heartjnl-2020-317550

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    Footnotes

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    • Contributors CK: contributed to conception or design, contributed to acquisition, analysis, interpretation, drafted the manuscript critically revised the manuscript, gave final approval and agrees to be accountable for all aspects of work ensuring integrity and accuracy. DK: contributed to interpretation, critically revised the manuscript, gave final approval. JPJ: contributed to the analysis of the data (statistical analysis). FR: drafted the manuscript and gave final approval. ML: critically revised the manuscript, gave final approval. VW: contributed to interpretation, critically revised the manuscript, gave final approval. GS: drafted the manuscript and gave final approval. FP: critically revised the manuscript, gave final approval. DB: contributed to interpretation, critically revised the manuscript, gave final approval. LI: contributed to interpretation, critically revised the manuscript, gave final approval. AL: contributed to conception or design, contributed to acquisition, analysis, interpretation, drafted the manuscript critically revised the manuscript, gave final approval and agrees to be accountable for all aspects of work ensuring integrity and accuracy

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The authors confirm that all procedures underlying this work have been approved by the institutional committee: Conseil d’Ethique de Necker-Enfants Malades (CENEM). Informed consent was obtained from each patient and the study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.

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