Open AccessExercise stress CMR reveals reduced aortic distensibility and impaired right-ventricular adaptation to exercise in patients with repaired tetralogy of Fallot
Author(s) -
Paul Habert,
Zakarya Bentatou,
Philippe Aldebert,
Mathieu Finas,
Axel Bartoli,
Laurence Bal,
Alain Lalande,
Stanislas Rapacchi,
Maxime Guye,
Frank Kober,
Monique Bernard,
Alexis Jacquier
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0208749
Subject(s) - cardiology , medicine , tetralogy of fallot , ascending aorta , heart rate , ejection fraction , supine position , vo2 max , aorta , blood pressure , heart disease , heart failure
Background The aim of our study was to evaluate the feasibility of exercise cardiac magnetic resonance (CMR) in patients with repaired tetralogy of Fallot (RTOF) and to assess right and left ventricular adaptation and aortic wall response to exercise in comparison with volunteers. Methods 11 RTOF and 11 volunteers underwent prospective CMR at rest and during exercise. A supine bicycle ergometer was employed to reach twice the resting heart rate during continuous exercise, blood pressure and heart rate were recorded. Bi-ventricular parameters and aortic stiffness were assessed using accelerated cine sequences and flow-encoding CMR. A t-test was used to compare values between groups. A Mann Whitney test was used to compare values within groups. Results In RTOF both ventricles showed an impaired contractile reserve (RVEF rest 36.2±8.3%, +1.3±3.9% increase after exercise; LVEF rest 53.8±6.1%, +5.7±6.4% increase after exercise) compared to volunteers (RVEF rest 50.5±5.0%, +10.4±7.1% increase after exercise, p = 0.039; LVEF rest 61.9±3.1%, +12.2±4.7% increase after exercise, p = 0.014). RTOF showed a reduced distensibility of the ascending aorta during exercise compared to volunteers (RTOF: 3.4±1.9 10-3.mmHg -1 vs volunteers: 5.1±1.4 10-3.mmHg - 1 ; p = 0.027). Ascending aorta distensibility was correlated to cardiac work in the volunteers but not in RTOF. Conclusion RTOF showed an impaired contractile reserve for both ventricles. The exercise unmasked a reduced distensibility of the ascending aorta in RTOF, which may be an early sign of increased aortic rigidity.