Right Ventricular Systolic Pressure Response During Exercise in Adolescents Born With Atrial or Ventricular Septal Defect

Möller, Thomas; Brun, Henrik; Fredriksen, Per Morten; Holmstrøm, Henrik; Peersen, Kari; Pettersen, Eirik; Grünig, Ekkehard; Mereles, Derliz; Thaulow, Erik

doi:10.1016/j.amjcard.2010.01.024

Cited by 42 publications

(43 citation statements)

References 23 publications

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“…2 SD [23]. Patients were partly (n = 9) recruited among the population in a recently published study of the prevalence of exercise related pulmonary hypertension [22] and partly (n = 5) through exercise echocardiography screening of 10 patients who had undergone surgery for moderate or large VSD. These were contacted as they appeared consecutively during a search in the Norwegian pediatric heart registry (BERTE) [13].…”

Section: Methodsmentioning

confidence: 99%

“…Increased RVSP during exercise has further been demonstrated in left cardiac disease [26]. We recently published the first study of exercise related pulmonary hypertension in patients with cardiac septal defects, questioning the occurrence of subclinical PAH in one-third of this patient group [22]. Potential mechanisms behind this phenomenon are the objectives of the present study.…”

Section: Introductionmentioning

confidence: 91%

“…The mechanisms behind these phenomena could include both precapillary and postcapillary elements, but this has not been studied. Exercise echocardiography has been widely used to study the right-ventricular systolic pressure (RVSP) in health and disease, and normal values have been suggested [3,14,22,23]. As observed in idiopathic PAH gene carriers and in connective tissue disease, asymptomatic patients may demonstrate abnormally increased pulmonary blood pressure during exercise only [12], possibly representing subclinical or early pulmonary arteriolar disease.…”

Section: Introductionmentioning

confidence: 98%

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Mechanisms of Exercise-Induced Pulmonary Hypertension in Patients With Cardiac Septal Defects

et al. 2012

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The objective of this study was to investigate mechanisms of exercise-induced pulmonary hypertension in patients with congenital cardiac septal defects. This was a randomized, placebo controlled, crossover drug trial in a single national pediatric cardiology centre that performs congenital cardiac defect surgery. There were 14 patients with cardiac septal defects and known exercise-induced pulmonary hypertension. The intervention consisted of 50 mg oral sildenafil versus placebo. Measurements included supine bicycle exercise echocardiography and oxygen uptake. The outcome measure was right-ventricular systolic pressure as estimated by Doppler tracings of tricuspid regurgitant jet as well as systolic and diastolic longitudinal myocardial velocities by color tissue Doppler echocardiography. Sildenafil did not change exercise right-ventricular systolic pressure during exercise; however, decreased systemic systolic pressure was seen. Enhanced biventricular longitudinal function with sildenafil compared with placebo was indicated by greater tissue Doppler velocities and displacement measurements during exercise. Finally, a less steep increase of right-ventricular pressure during exercise was associated with greater left-ventricular diastolic myocardial tissue Doppler velocity. Exercise-induced pulmonary hypertension in cardiac septal defects does not seem to have a pulmonary vasoconstrictive component, but it may be related to left-ventricular filling pressure. Furthermore, sildenafil improved biventricular systolic performance in this patient group, possibly related to decreased systemic afterload.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 98%

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Mechanisms of Exercise-Induced Pulmonary Hypertension in Patients With Cardiac Septal Defects

et al. 2012

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“…3,9 Nevertheless, studies suggest residual impaired exercise capacity after closure in a substantial fraction of patients. [3][4][5] Recently, Cuypers et al 3 reported impaired exercise capacity, increased RV volumes, and mild RV dysfunction in one-third of repaired-ASD patients, using echocardiography and cardiac magnetic resonance imaging. Using similar methodology, de Koning et al 10 documented residual RV dilatation but normal exercise capacity.…”

Section: Ventricular-arterial Interactionmentioning

confidence: 99%

“…However, while most patients have resolution of RV dilation, some studies demonstrate that, in a sizable subset of patients, RV dilation may persist and maximal exercise capacity may remain impaired in longterm follow-up. [3][4][5] In theory, exercise impairment due to cardiovascular limitation could result from persistent, underrecognized changes in the RV and the pulmonary arterial (PA) bed. Epstein and colleagues 6 published unique invasive exercise-hemodynamics data for asymptomatic patients who had undergone ASD closure.…”

Section: Introductionmentioning

confidence: 99%

Impaired Exercise Capacity following Atrial Septal Defect Closure: An Invasive Study of the Right Heart and Pulmonary Circulation

et al. 2014

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Patients with early repair of an isolated atrial septal defect (ASD) are expected to have unremarkable right ventricular (RV) and pulmonary circulation physiology. Some studies, however, suggest persistent functional impairment. We aimed to examine the role of abnormal RV and pulmonary vascular response to exercise in patients who had undergone ASD closure. Using a previously published data set, we reviewed invasive exercise cardiopulmonary testing with right-sided hemodynamic data for 12 asymptomatic patients who had undergone ASD closure. The 5 (42%) patients with impaired maximal oxygen uptake (V : o 2max ) were older and exhibited a lower peak cardiac index (5.6 AE 0.8 vs. 9.0 AE 1.2 L/min/m 2 ; P ¼ .005) because of abnormal stroke volume augmentation (þ3.2 AE 3.9 vs. þ17.4 AE 10.2 mL/m 2 ; P ¼ .02). While all resting hemodynamic variables were similar, patients with low V :o 2max tended to have abnormal total pulmonary vascular resistance change during exercise (þ11% AE 41% vs. −28% AE 26%; P ¼ .06) and had a steeper relation between mean pulmonary arterial pressure and cardiac index (5.8 AE 0.6 vs. 2.2 AE 0.1 L/min/m 2 ; P ¼ .02). The increase in peak mean RV power during exercise was also significantly lower in the impaired-V: o 2max patients (4.7 AE 1.6 vs. 7.6 AE 2.1 J/s; P ¼ .04). As described in the original study, despite normal resting hemodynamics, a subset of asymptomatic patients with repaired ASD had diminished exercise capacity. Our analysis allows us to conclude that this is due to a combination of abnormal pulmonary vascular response to exercise and impaired RV function.

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Feasibility of semi-recumbent bicycle exercise Doppler echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the RIGHT heart international NETwork (RIGHT-NET)

Ferrara

Gargani

Naeije³

et al. 2021

Int J Cardiovasc Imaging

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Right Ventricular Systolic Pressure Response During Exercise in Adolescents Born With Atrial or Ventricular Septal Defect

Cited by 42 publications

References 23 publications

Mechanisms of Exercise-Induced Pulmonary Hypertension in Patients With Cardiac Septal Defects

Mechanisms of Exercise-Induced Pulmonary Hypertension in Patients With Cardiac Septal Defects

Impaired Exercise Capacity following Atrial Septal Defect Closure: An Invasive Study of the Right Heart and Pulmonary Circulation

Feasibility of semi-recumbent bicycle exercise Doppler echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the RIGHT heart international NETwork (RIGHT-NET)

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