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.
Subject(s)
Cardiac Output, Low/metabolism , Cardiac Output, Low/physiopathology , Exercise Test , Oxygen Consumption , Pulmonary Valve Insufficiency/metabolism , Pulmonary Valve Insufficiency/physiopathology , Adolescent , Adult , Cardiac Output, Low/etiology , Child , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Pulmonary Valve Insufficiency/complications , Retrospective Studies , Severity of Illness Index , Young AdultABSTRACT
INTRODUCTION AND OBJECTIVES: Pulmonary regurgitation (PR) is a frequent complication after repair of congenital heart disease. Lymphocyte expression of adrenoceptors (ß1 and ß2) and kinases (GRK2, GRK3, and GRK5) reflects the neurohumoral changes that occur in heart failure (HF). The main objective of this study was to describe the gene expression of these molecules in circulating lymphocytes in patients with severe PR. METHODS: A prospective study was conducted to analyze lymphocyte expression of these molecules in patients with severe PR and compare it with expression in healthy controls and patients with advanced HF. RESULTS: We studied 35 patients with severe PR, 22 healthy controls, and 13 patients with HF. Multiple comparisons analysis showed that ß2-adrenoceptor gene expression levels were higher in the control group than in patients in the PR and HF groups and that expression in the latter 2 groups was similar (748.49 [rank 1703.87] vs 402.80 [rank 1210.81] vs 287.46 [rank 685.69] P = .001). Similar findings were obtained in gene expression of GRK2 (760.89 [rank 1169.46] vs 445.17 [rank 1190.69] vs 284.09 [rank 585.27] P < .001). There were no differences in expression levels of these molecules according to clinical variables in patients with PR. CONCLUSIONS: The gene expression pattern of GRK2 and ß2-adrenoceptor as molecular markers of cardiac dysfunction was altered in patients with severe PR compared with controls and was similar to expression in patients with advanced HF.
Subject(s)
G-Protein-Coupled Receptor Kinases/genetics , Gene Expression Regulation , Pulmonary Valve Insufficiency/genetics , RNA/genetics , Receptors, Adrenergic/genetics , Adult , Chronic Disease , Female , Follow-Up Studies , G-Protein-Coupled Receptor Kinases/biosynthesis , Humans , Magnetic Resonance Imaging, Cine , Male , Middle Aged , Prospective Studies , Pulmonary Valve Insufficiency/diagnosis , Pulmonary Valve Insufficiency/metabolism , Receptors, Adrenergic/biosynthesisABSTRACT
BACKGROUND: Although surgical treatment for tetralogy of Fallot (TOF) has been used with considerable success, right ventricular function may remain altered after repair. The NT-proBNP assessment has been shown to be a reliable parameter for the heart failure assessment. AIM: To determine NT-proBNP values in assessment of right ventricular function in children after TOF correction. METHODS: In 20 patients after TOF correction aged from 10 to 17 years (follow-up period ranged from 7 to 16 years) NT-proBNP level at rest and after exertion, treadmill test and echocardiography were performed. In the control healthy children NT-proBNP level at rest was assessed. RESULTS: The mean values of NT-proBNP level in the TOF patients were significantly higher than in controls (11.0 +/- 12.0 fmol/l and 5.4 +/- 7.5 fmol/l, p < 0.05). In patients repaired with a transannular patch the mean value of NT-proBNP level was higher than in children operated on without a transannular patch (18.3 +/- 16.5 vs. 6.8 +/- 7.9 fmol/l, p < 0.05). In children in whom physiological shortening of QRS complex during treadmill test was observed, NT-proBNP level was lower (mean values at rest 5.0 +/- 4.8 fmol/l and after exertion 7.3 +/- 6.3 fmol/l) compared to patients with prolongation of QRS duration (mean values at rest 17.7 +/- 15.6 fmol/l and after exertion 20.3 +/- 17.8 fmol/l) (p < 0.05). Significant differences in NT-proBNP levels between children with severe pulmonary regurgitation and mild/moderate pulmonary regurgitation were detected (mean values at rest 18.6 +/- 15.0 vs. 4.2 +/- 3.9 fmol/l and after exertion 20.0 +/- 18.6 vs. 5.7 +/- 4.6 fmol/l) (p < 0.05). The NT-proBNP levels were also higher in children with severe tricuspid valve insufficiency compared to children with mild/moderate tricuspid valve regurgitation (mean values at rest 19.5 +/- 15.0 vs. 4.9 +/- 3.7 fmol/l and after exertion 22.5 +/- 17.1 vs. 7.0 +/- 4.6 fmol/l). CONCLUSIONS: The NT-proBNP level in patients after TOF correction is higher than in healthy children. The NT-proBNP level is higher and exertion tolerance is lower in children repaired with rather than without transannular patch. In patients with severe pulmonary regurgitation and/or severe tricuspid valve insufficiency NT-proBNP level is higher than in patients without right ventricular volume overload. The measurement of NT-proBNP level might be helpful in order to separate those patients after TOF correction who are at increased risk of heart failure and arrhythmia.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Natriuretic Peptide, Brain/metabolism , Peptide Fragments/metabolism , Tetralogy of Fallot/surgery , Ventricular Dysfunction, Right/diagnosis , Adolescent , Biomarkers/metabolism , Child , Echocardiography , Exercise Test , Female , Humans , Male , Pulmonary Valve Insufficiency/diagnosis , Pulmonary Valve Insufficiency/etiology , Pulmonary Valve Insufficiency/metabolism , Pulmonary Valve Stenosis/diagnosis , Pulmonary Valve Stenosis/etiology , Pulmonary Valve Stenosis/metabolism , Tetralogy of Fallot/complications , Tricuspid Valve Insufficiency/diagnosis , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/metabolism , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/metabolismABSTRACT
The observed growth failure in infants with pulmonary insufficiency is postulated to be a consequence of elevated rates of energy expenditure. Assessment of energy expenditure by the classical technique of indirect calorimetry has yielded conflicting results. The adoption of the newer, doubly labeled water technique has provided evidence to support increased rates of energy expenditure in infants with chronic lung disease, congenital heart disease and in minimally ill, extremely low birth weight infants. The doubly labeled water technique holds great promise for the detailed study of energy expenditure in a variety of clinical conditions, including very ill as well as free-living subjects.
