Functional and haemodynamic assessment of mild-to-moderate pulmonary valve stenosis at rest and during exercise.
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.


BACKGROUND
NCT01444222.
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Pieter
P
De Meester
Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium.
Roselien
R
Buys
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Alexander
A
Van De Bruaene
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Charlien
C
Gabriels
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Jens-Uwe
JU
Voigt
Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium.
Luc
L
Vanhees
Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
Paul
P
Herijgers
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Els
E
Troost
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Werner
W
Budts
D000328:Adult; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D012720:Severity of Illness Index; D016278:Ventricular Function, Right; D017725:Ventricular Pressure; D055815:Young Adult