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Total isovolumic time relates to exercise capacity in patients with transposition of the great arteries late after atrial switch procedures

Published online by Cambridge University Press:  09 November 2011

Edgar L. W. Tay*
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom Cardiology Department, National University Heart Centre, Singapore
Derek Gibson
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
Ryo Inuzuka
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
Manjit Josen
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
Rafael Alonso-Gonzalez
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
Georgios Giannakoulas
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
Wei Li
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
Konstantinos Dimopoulos
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom National Heart Lung Institute, Imperial College of Science and Medicine, London, United Kingdom
Michael A. Gatzoulis
Affiliation:
Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom National Heart Lung Institute, Imperial College of Science and Medicine, London, United Kingdom
*
Correspondence to: Dr E. L. W. Tay, MBBS, MRCP, Consultant Cardiologist, Cardiology Department, National University Heart Centre, National University Health System Tower Block Level 9, 1E Kent Ridge Road, Singapore 119228, Singapore. Tel: +1 65 67725260; Fax: +1 65 68722998; E-mail: Edgar_Tay@nuhs.edu.sg

Abstract

Background

Systemic right ventricular systolic dysfunction is common late after atrial switch surgery for transposition of the great arteries. Total isovolumic time is the time that the ventricle is neither ejecting nor filling and is calculated without relying on geometric assumptions. We assessed resting total isovolumic time in this population and its relationship to exercise capacity.

Methods

A total of 40 adult patients with transposition of the great arteries after atrial switch – and 10 healthy controls – underwent transthoracic echocardiography and cardiopulmonary exercise testing from January, 2006 to January, 2009. Resting total isovolumic time was measured in seconds per minute: 60 minus total ejection time plus total filling time.

Results

The mean age was 31.6 plus or minus 7.6 years, and 38.0% were men. There were 16 patients (40%) who had more than or equal to moderate systolic dysfunction of the right ventricle. Intra- and inter-observer agreement was good for total isovolumic time, which was significantly prolonged in patients compared with controls (12.0 plus or minus 3.9 seconds per minute versus 6.0 plus or minus 1.8 seconds per minute, p-value less than 0.001) and correlated significantly with peak oxygen consumption (r equals minus 0.63, p-value less than 0.001). The correlation strengthened (r equals minus 0.73, p-value less than 0.001) after excluding seven patients with exercise-induced cyanosis. No relationship was found between exercise capacity and right ventricular ejection fraction or long-axis amplitude.

Conclusion

Resting isovolumic time is prolonged after atrial switch for patients with transposition of the great arteries. It is highly reproducible and relates well to exercise capacity.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2012

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References

1. Graham, TP Jr, Burger, J, Bender, HW, Hammon, JW, Boucek, RJ Jr, Appleton, S. Improved right ventricular function after intra-atrial repair of transposition of the great arteries. Circulation 1985; 72: II45II51.Google ScholarPubMed
2. Roos-Hesselink, JW, Meijboom, FJ, Spitaels, SE, et al. Decline in ventricular function and clinical condition after Mustard repair for transposition of the great arteries (a prospective study of 22–29 years). Eur Heart J 2004; 25: 12641270.CrossRefGoogle ScholarPubMed
3. Wong, KY, Venables, AW, Kelly, MJ, Kalff, V. Longitudinal study of ventricular function after the Mustard operation for transposition of the great arteries: a long term follow up. Br Heart J 1988; 60: 316323.CrossRefGoogle ScholarPubMed
4. Benson, LN, Bonet, J, McLaughlin, P, et al. Assessment of right ventricular function during supine bicycle exercise after Mustard's operation. Circulation 1982; 65: 10521059.CrossRefGoogle ScholarPubMed
5. Musewe, NN, Reisman, J, Benson, LN, et al. Cardiopulmonary adaptation at rest and during exercise 10 years after Mustard atrial repair for transposition of the great arteries. Circulation 1988; 77: 10551061.CrossRefGoogle ScholarPubMed
6. Giardini, A, Hager, A, Lammers, AE, et al. Ventilatory efficiency and aerobic capacity predict event-free survival in adults with atrial repair for complete transposition of the great arteries. J Am Coll Cardiol 2009; 53: 15481555.CrossRefGoogle ScholarPubMed
7. Hechter, SJ, Webb, G, Fredriksen, PM, et al. Cardiopulmonary exercise performance in adult survivors of the Mustard procedure. Cardiol Young 2001; 11: 407414.CrossRefGoogle ScholarPubMed
8. Li, W, Hornung, TS, Francis, DP, et al. Relation of biventricular function quantified by stress echocardiography to cardiopulmonary exercise capacity in adults with Mustard (atrial switch) procedure for transposition of the great arteries. Circulation 2004; 110: 13801386.CrossRefGoogle ScholarPubMed
9. Roest, AA, Lamb, HJ, van der Wall, EE, et al. Cardiovascular response to physical exercise in adult patients after atrial correction for transposition of the great arteries assessed with magnetic resonance imaging. Heart 2004; 90: 678684.CrossRefGoogle ScholarPubMed
10. Duncan, AM, Francis, DP, Gibson, DG, Henein, MY. Limitation of exercise tolerance in chronic heart failure: distinct effects of left bundle-branch block and coronary artery disease. J Am Coll Cardiol 2004; 43: 15241531.CrossRefGoogle ScholarPubMed
11. Duncan, A, Wait, D, Gibson, D, Daubert, JC. Left ventricular remodelling and haemodynamic effects of multisite biventricular pacing in patients with left ventricular systolic dysfunction and activation disturbances in sinus rhythm: sub-study of the MUSTIC (Multisite Stimulation in Cardiomyopathies) trial. Eur Heart J 2003; 24: 430441.CrossRefGoogle Scholar
12. Duncan, AM, Lim, E, Clague, J, Gibson, DG, Henein, MY. Comparison of segmental and global markers of dyssynchrony in predicting clinical response to cardiac resynchronization. Eur Heart J 2006; 27: 24262432.CrossRefGoogle ScholarPubMed
13. Diller, GP, Dimopoulos, K, Okonko, D, et al. Exercise intolerance in adult congenital heart disease: comparative severity, correlates, and prognostic implication. Circulation 2005; 112: 828835.CrossRefGoogle ScholarPubMed
14. Dimopoulos, K, Okonko, DO, Diller, GP, et al. Abnormal ventilatory response to exercise in adults with congenital heart disease relates to cyanosis and predicts survival. Circulation 2006; 113: 27962802.CrossRefGoogle ScholarPubMed
15. Henry, WL, DeMaria, A, Gramiak, R, et al. Report of the American Society of Echocardiography Committee on nomenclature and standards in two-dimensional echocardiography. Circulation 1980; 62: 212217.CrossRefGoogle ScholarPubMed
16. Tei, C, Dujardin, KS, Hodge, DO, Kyle, RA, Tajik, AJ, Seward, JB. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol 1996; 28: 658664.CrossRefGoogle ScholarPubMed
17. Tei, C, Ling, LH, Hodge, DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function – a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357366.Google ScholarPubMed
18. Tei, C, Nishimura, RA, Seward, JB, Tajik, AJ. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 1997; 10: 169178.CrossRefGoogle ScholarPubMed
19. Mustard, WT, Keith, JD, Trusler, GA, Fowler, R, Kidd, L. The surgical management of transposition of the great vessels. J Thorac Cardiovasc Surg 1964; 48: 953958.CrossRefGoogle ScholarPubMed
20. Senning, A. Surgical correction of transposition of the great vessels. Surgery 1959; 45: 966980.Google ScholarPubMed
21. Chow, PC, Liang, XC, Lam, WW, Cheung, EW, Wong, KT, Cheung, YF. Mechanical right ventricular dyssynchrony in patients after atrial switch operation for transposition of the great arteries. Am J Cardiol 2008; 101: 874881.CrossRefGoogle ScholarPubMed
22. Mancini, DM, Eisen, H, Kussmaul, W, Mull, R, Edmunds, LH Jr, Wilson, JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991; 83: 778786.CrossRefGoogle ScholarPubMed
23. Salehian, O, Schwerzmann, M, Merchant, N, Webb, GD, Siu, SC, Therrien, J. Assessment of systemic right ventricular function in patients with transposition of the great arteries using the myocardial performance index: comparison with cardiac magnetic resonance imaging. Circulation 2004; 110: 32293233.CrossRefGoogle ScholarPubMed
24. Duncan, AM, Francis, DP, Henein, MY, Gibson, DG. Importance of left ventricular activation in determining myocardial performance (Tei) index: comparison with total isovolumic time. Int J Cardiol 2004; 95: 211217.CrossRefGoogle ScholarPubMed
25. Diller, GP, Okonko, DO, Uebing, A, et al. Impaired heart rate response to exercise in adult patients with a systemic right ventricle or univentricular circulation: prevalence, relation to exercise, and potential therapeutic implications. Int J Cardiol 2009; 134: 5966.CrossRefGoogle ScholarPubMed
26. Gatzoulis, MA, Walters, J, McLaughlin, PR, Merchant, N, Webb, GD, Liu, P. Late arrhythmia in adults with the Mustard procedure for transposition of great arteries: a surrogate marker for right ventricular dysfunction? Heart 2000; 84: 409415.CrossRefGoogle ScholarPubMed
27. Babu-Narayan, SV, Goktekin, O, Moon, JC, et al. Late gadolinium enhancement cardiovascular magnetic resonance of the systemic right ventricle in adults with previous atrial redirection surgery for transposition of the great arteries. Circulation 2005; 111: 20912098.CrossRefGoogle ScholarPubMed
28. Giannakoulas, G, Dimopoulos, K, Engel, R, et al. Burden of coronary artery disease in adults with congenital heart disease and its relation to congenital and traditional heart risk factors. Am J Cardiol 2009; 103: 14451450.CrossRefGoogle ScholarPubMed
29. Schaefer, A, Tallone, EM, Westhoff-Bleck, M, Klein, G, Drexler, H, Röntgen, P. Relation of diastolic and systolic function, exercise capacity and brain natriuretic peptide in adults after Mustard procedure for transposition of the great arteries. Cardiology 2010; 117: 112117.CrossRefGoogle ScholarPubMed