Relation of systemic ventricular function quantified by myocardial performance index (Tei) to cardiopulmonary exercise capacity in adults after Mustard procedure for transposition of the great arteries.
After Mustard repair for transposition of the great arteries, the right ventricle serves as a chronically overloaded systemic ventricle (SV). Thus, during long-term follow-up, dysfunction of the right ventricle with consecutive heart failure (HF) is not unusual. Early signs and symptoms of HF are depressed parameters of right ventricular (RV) function at rest and exercise intolerance. It was hypothesized that the measurement of RV function parameters, N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and peak oxygen uptake (VO2max) during exercise testing were suitable for the early detection of subclinical HF. In 33 asymptomatic adolescents and adults who had undergone Mustard repair, RV function was analyzed by the myocardial performance index (Tei index). NT-pro-BNP and VO2max were also determined. The corresponding data from 52 patients operated on for left-to-right shunt defects without residual lesions served as reference data. In patients who underwent the Mustard procedure, the Tei index and NT-pro-BNP were elevated (mean Tei index of the SV 0.63 +/- 0.17 vs 0.34 +/- 0.05, p <0.002; mean NT-pro-BNP 240 +/- 230 vs 57 +/- 39 pg/ml, p <0.0001), and VO2max was reduced (27 +/- 6 vs 32 +/- 6 ml x kg(-1) x min(-1), p <0.002). A good correlation was found between the Tei index and VO2max (r = -0.83, p <0.0001). In conclusion, RV function is depressed in most patients with Mustard repair. Ventricular dysfunction in such asymptomatic or minimally symptomatic patients can be detected by measurement of the Tei index, NT-pro-BNP, and VO2max. These parameters are simple and reliable screening methods to stratify patients with impaired cardiac dysfunction before they become symptomatic.
Norozi
Kambiz
K
Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Germany. norozi.kambiz@mh-hannover.de
Buchhorn
Reiner
R
Alpers
Valentin
V
Arnhold
Jan O
JO
Schoof
Stephan
S
Zoege
Monika
M
Geyer
Siegfried
S
Wessel
Armin
A
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D015588:Observer Variation; D010101:Oxygen Consumption / Q000502:physiology; D010446:Peptide Fragments / Q000097:blood; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D014188:Transposition of Great Vessels / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D016278:Ventricular Function, Right / Q000502:physiology*
D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain