Declining Cardiopulmonary Exercise Capacity Is Not Associated with Worsening Systolic Systemic Ventricular Dysfunction in Adults with Transposition of Great Arteries after Atrial Switch Operation

Abstract

After atrial switch operation for transposition of the great arteries we observed a declining functional exercise capacity. This was not associated with worsening systemic right ventricular function, suggesting that other factors are contributing to the decline in physical exercise capacity.

Myocardial Deformation in the Systemic Right Ventricle: Strain Imaging Improves Prediction of the Failing Heart

“…12 However, its association with functional decline and exercise capacity remains limited. 28,34 Furthermore, access to CMR may be restricted by scanner availability, costs, and noncompatible implantable devices or other metallic objects. Adding STE measures to routine echocardiography in patients with sRV is a simple and low-cost way to quantitatively assess the sRV, which can also be done in patients unsuitable for CMR.…”

Myocardial fibrosis and its relation to adverse outcome in transposition of the great arteries with a systemic right ventricle

“…[19] There is lack of congruity between functional decline and change in EF or BNP. [20] In fact, self-assessment has been more predictive of clinical deterioration than objective parameters. [21]…”

Heart rate response during exercise predicts exercise tolerance in adults with transposition of the great arteries and atrial switch operation

“…reported a low to moderate correlation between longitudinal strain and exercise capacity [17], recent studies with advanced CMR techniques including longitudinal and circumferential strain showed poor to absence of correlation [13][14][15][16][17][18] between function resting parameters and exercise capacity. This suggests that a resting imaging follow-up alone may be insufficient to explore exercise intolerance [19].…”

“…Contradictory results have been observed regarding the correlation between sRV function evaluated by echocardiography or Cardiac Magnetic Resonance Imaging (CMRI) and exercise intolerance [12][13][14][15][16][17][18][19]. Inadequate heart rate response to exercise (chronotropic incompetence) is prevalent in this population and may play a role in this intolerance [20].…”