Kingsley Clotilde, Ahmad Saad, Pappachan John, Khambekar Sujata, Smith Thomas, Gardiner Diane, Shambrook James, Baskar Shankar, Moore Ryan, Veldtman Gruschen
Department of Congenital Heart Disease, Southampton University Hospital, Wessex Cardiothoracic Centre, Southampton, UK.
Division of Cardiovascular Health and Diseases, University of Cincinnati, Cincinnati, Ohio, USA.
Congenit Heart Dis. 2018 Mar;13(2):288-294. doi: 10.1111/chd.12569. Epub 2018 Jan 5.
The right ventricular (RV) contractile reserve is a measure of the dynamic function of the RV and is a sensitive indicator of volume load. This can be measured noninvasively using the tricuspid annular plane systolic excursion (TAPSE) during exercise. We studied the RV contractile reserve of patients after tetralogy of Fallot (TOF) repair with varying degree of RV dilation and pulmonary regurgitation (PR), and compared them to a control group.
Twenty-six patients who had undergone TOF repair (mean age 29 ± 10 years) were identified and stratified into three group based on the presence and severity of RV dilation and PR. We recruited 13 age- and sex-matched controls with normal cardiac anatomy for comparison. After obtaining a baseline echocardiogram in the resting state, patients underwent exercise testing on a treadmill utilizing Bruce protocol. At maximal voluntary ability during the exercise testing, the patient was immediately laid down on an echocardiography couch, and a peak exercise echocardiogram was obtained.
TOF patients, regardless of RV size and PR severity, had significantly shorter exercise duration (685 vs 802 s, P = .02), lower TAPSE at rest (1.7 vs 2.3 cm, P < 0.001) and at peak exercise (1.6 ± 0.4 vs 2.6 ± 0.5 cm P < .001) when compared to the control group. Patients with RV dilation were more likely to have worse RV contractile reserve but increased TAPSE and tricuspid annular acceleration at rest when compared to patients without RV dilation.
TOF patients with dilated RV and PR have worse RV function at rest and during exercise, compared to TOF subjects without RV dilation. Long-axis RV contractile reserve as assessed by TAPSE, was lower in TOF subjects versus controls, and was worse in those with significant RV dilation, suggesting a decline in contractile reserve with an increase in RV volume.
右心室（RV）收缩储备是衡量右心室动态功能的指标，也是容量负荷的敏感指标。这可以在运动期间使用三尖瓣环平面收缩期位移（TAPSE）进行无创测量。我们研究了法洛四联症（TOF）修复术后不同程度右心室扩张和肺动脉反流（PR）患者的右心室收缩储备，并将其与对照组进行比较。
确定26例接受TOF修复术的患者（平均年龄29±10岁），并根据右心室扩张和PR的存在及严重程度分为三组。我们招募了13名心脏解剖结构正常、年龄和性别匹配的对照者进行比较。在静息状态下获得基线超声心动图后，患者按照布鲁斯方案在跑步机上进行运动测试。在运动测试中达到最大自主能力时，患者立即躺在超声心动图检查床上，获取运动高峰时的超声心动图。
与对照组相比，TOF患者无论右心室大小和PR严重程度如何，运动持续时间均显著缩短（685秒对802秒，P = 0.02），静息时TAPSE较低（1.7厘米对2.3厘米，P < 0.001），运动高峰时也较低（1.6±0.4厘米对2.6±0.5厘米，P < 0.001）。与无右心室扩张的患者相比，右心室扩张的患者右心室收缩储备更可能较差，但静息时TAPSE和三尖瓣环加速度增加。
与没有右心室扩张的TOF患者相比，右心室扩张和PR的TOF患者在静息和运动时右心室功能更差。通过TAPSE评估的右心室长轴收缩储备，TOF患者低于对照组，且在右心室显著扩张的患者中更差，提示收缩储备随右心室容量增加而下降。
