Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?
BACKGROUND
The aim of the study was to evaluate the role of cardiopulmonary exercise testing (CPET) parameters in assessing exercise capacity improvement after percutaneous pulmonary valve implantation (PPVI). Additionally, it aimed to determine if there are any baseline characteristics influencing that change.


RESULTS
The study comprised 32 patients (mean age 26 ± 9); 53% males; diagnosis: tetralogy of Fallot (n = 18), pulmonary atresia (n = 6), Ross procedure (n = 4), other (transposition of great arteries, pulmonary stenosis, double outlet right ventricle, common arterial trunk type II--n = 4) who underwent successful PPVI due to right ventricular out-flow tract dysfunction (predominant pulmonary regurgitation--n = 17, predominant pulmonary stenosis--n = 15). Treadmill CPET was performed before and a year after PPVI along with clinical evaluation, cardiac magnetic resonance and transthoracic echocardiography. Twelve months post successful PPVI (pulmonary valve competence restoration and pulmonary gradient reduction from 58.8 ± 47.1 to 26.6 ± 10.8 mm Hg) there was a significant decrease in the ventilatory equivalent for CO2 at peak exercise (EQCO₂) (25.3 ± 3.3 to 24.3 ± 3.0, p = 0.04) and oxygen consumption at peak exercise (pVO2) (20.4 ± 5.0 to 22.6 ± 5.3 mL/kg/min, p = 0.04). Improved EQCO2 correlated with an increase in right and left ventricular ejection fraction (respectively R = -0.57, p = 0.002; R = -0.56, p = 0.002). In this study, no baseline factors that might affect improvement in exercise function were found.


CONCLUSIONS
Successful PPVI leads to an improvement in exercise capacity and hemodynamic response to exercise. The correlation between the improvement in EQCO2 or peak VO2 and baseline characteristics was too weak to reliably identify the group of patients that will benefit from the procedure.
Department of Congenital Heart Diseases, Institute of Car diology Warsaw. k.biernacka@ikard.pl.
Elżbieta Katarzyna
EK
Biernacka
Ewa
E
Piotrowicz
Aneta
A
Fronczak
Magdalena
M
Mazgaj
Marcin
M
Demkow
Witold
W
Rużyłło
Mateusz
M
Śpiewak
Mirosław
M
Kowalski
Ryszard
R
Piotrowicz
Krzysztof
K
Weroński
Piotr
P
Hoffman
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D004452:Echocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010101:Oxygen Consumption; D018579:Patient Selection; D011237:Predictive Value of Tests; D011664:Pulmonary Valve / Q000503:physiopathology*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult