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Surkova E, Lakatos BK, Fábián A, Kovács A, Senior R, Li W. Myocardial work of the systemic right ventricle and its association with outcomes. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1105-1114. [PMID: 38507153 DOI: 10.1007/s10554-024-03081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
We aimed to evaluate clinical and prognostic significance of myocardial work parameters of the systemic right ventricle (SRV). Thirty-eight patients with the SRV underwent echocardiographic assessment of the SRV systolic function including 3D-echocardiography derived ejection fraction, 2D longitudinal strain and myocardial work analysis. The study endpoint was the combination of all-cause mortality and heart transplantation. Global constructive work (GCW) and global work index (GWI) demonstrated moderate correlation with the 3DE-derived SRV ejection fraction (EF) (Rho 0.64, p < 0.0001 and Rho 0.63, p < 0.0001, respectively). GCW showed the strongest correlation with the BNP level (Rho - 0.77, p < 0.0001), closely followed by GWI, 4-chamber longitudinal strain and 3DE EF (all Rho - 0.73, p < 0.0001). GCW and GWI were significantly lower in patients with moderate or severe tricuspid regurgitation compared with less than moderate regurgitation (1226 ± 439 vs 1509 ± 264 mmHg%, p = 0.02, and 984 ± 348 vs 1259 ± 278 mmHg%, p = 0.01, respectively). During a follow-up of 3.5 (2.8-3.9) years, seven patients (18%) died and one received transplantation (3%). They had significantly lower GCW and GWI compared with patients who did not reach the study endpoint (908 ± 255 vs 1433 ± %, p < 0.001 and 721 ± 210 vs 1173 ± 315 mmHg%, p < 0.001, respectively). In Cox regression analysis, GCW, GWI, 3DE SRV volumes and EF were the best-fit models based on the Akaike Information Criterion, outperforming longitudinal strain parameters. GWI and GCW, novel echocardiographic parameters of myocardial work, provided reliable quantification of the SRV systolic function. GWI, GCW and 3DE-derived SRV parameters were closely associated with all-cause mortality and heart transplantation in patients with the SRV.
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Affiliation(s)
- Elena Surkova
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London, SW3 6NP, UK.
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest, 1122, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest, 1122, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest, 1122, Hungary
| | - Roxy Senior
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London, SW3 6LY, UK
| | - Wei Li
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London, SW3 6LY, UK
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Surkova E, Constantine A, Xu Z, Segura de la Cal T, Bispo D, West C, Senior R, Dimopoulos K, Li W. Prognostic significance of subpulmonary left ventricular size and function in patients with a systemic right ventricle. Eur Heart J Cardiovasc Imaging 2023; 25:58-65. [PMID: 37453129 DOI: 10.1093/ehjci/jead173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/19/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
AIMS To assess the additional prognostic significance of echocardiographic parameters of subpulmonary left ventricular (LV) size and function in patients with a systemic right ventricle (SRV). METHODS AND RESULTS All adults with an SRV who underwent transthoracic echocardiography in 2010-18 at a large tertiary centre were identified. Biventricular size and function were assessed at the most recent examination. The study endpoint was all-cause mortality or heart/heart-lung transplantation. We included 180 patients, with 100 (55.6%) males, with a mean age of 42.4 ± 12.3 years, of whom 103 (57.2%) had undergone Mustard/Senning operations and 77 (42.8%) had congenitally corrected transposition of great arteries. Over 4.9 (3.8-5.7) years, 28 (15.6%) patients died and 4 (2.2%) underwent heart or heart-lung transplantation. Univariable predictors of the study endpoint included age, New York Heart Association functional Class III or IV, history of atrial arrhythmias, presence of a pacemaker or cardioverter defibrillator, high B-type natriuretic peptide, and echocardiographic markers of SRV and subpulmonary LV size and function. On multivariable Cox analysis of echocardiographic variables, indexed LV end-systolic diameter [ESDi; hazard ratio (HR) 2.77 (95% confidence interval, CI) 1.35-5.68, P = 0.01], LV fractional area change [FAC; HR 0.7 (95% CI 0.57-0.85), P = 0.002), SRV basal diameter [HR 1.66 (95% CI 1.21-2.29), P = 0.005], and SRV FAC [HR 0.65 (95% CI 0.49-0.87), P = 0.008] remained predictive of mortality or transplantation. On receiver-operating characteristic analysis, subpulmonary LV parameters performed better than SRV markers in predicting adverse events. CONCLUSION SRV basal diameter, SRV FAC, LV ESDi, and LV FAC are significantly and independently associated with mortality and transplantation in adults with an SRV. Accurate echocardiographic assessment of both SRV and subpulmonary LV is, therefore, essential to inform risk stratification and management.
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Affiliation(s)
- Elena Surkova
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
| | - Zhuoyuan Xu
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
| | - Teresa Segura de la Cal
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
- Adult Congenital Heart Disease Unit, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Daniela Bispo
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
| | - Cathy West
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
| | - Roxy Senior
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
| | - Wei Li
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
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Ciuca C, Balducci A, Angeli E, Di Dio M, Assenza GE, Mariucci E, Ragni L, Lovato L, Niro F, Gesuete V, Careddu L, Bartolacelli Y, Bulgarelli A, Donti A, Gargiulo GD. Long Term Follow-Up of Patients with Systemic Right Ventricle and Biventricular Physiology: A Single Centre Experience. J Cardiovasc Dev Dis 2023; 10:jcdd10050219. [PMID: 37233186 DOI: 10.3390/jcdd10050219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND A progressively increasing prevalence of congenital heart disease (CHD) in adulthood has been noticed in recent decades; CHD cases with a systemic right ventricle have a poorer outcome. METHODS Seventy-three patients with SRV evaluated in an outpatient clinic between 2014 and 2020 were enrolled in this study. Thirty-four patients had a transposition of the great arteries treated with an atrial switch operation; 39 patients had a congenitally corrected transposition of the great arteries (ccTGA). RESULTS Mean age at the first evaluation was 29.6 ± 14.2 years; 48% of the patients were female. The NYHA class at the visit was III or IV in 14% of the cases. Thirteen patients had at least one previous pregnancy. In 25% of the cases, complications occurred during pregnancy. Survival free from adverse events was 98.6% at one year and 90% at 6-year follow-up without any difference between the two groups. Two patients died and one received heart transplantation during follow-up. The most common adverse event during follow-up was the presence of arrhythmia requiring hospitalization (27.1%), followed by heart failure (12.3%). The presence of LGE together with lower exercise capacity, higher NYHA class and more dilated and/or hypokinetic RV predicted a poorer outcome. Quality of life was similar to the QoL of the Italian population. CONCLUSIONS Long-term follow-up of patients with a systemic right ventricle is characterized by a high incidence of clinical events, prevalently arrhythmias and heart failure, which cause most of the unscheduled hospitalizations.
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Affiliation(s)
- Cristina Ciuca
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Anna Balducci
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Emanuela Angeli
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Mariateresa Di Dio
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gabriele Egidy Assenza
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elisabetta Mariucci
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Ragni
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luigi Lovato
- Radiology Unit, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Fabio Niro
- Radiology Unit, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Gesuete
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lucio Careddu
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ylenia Bartolacelli
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ambra Bulgarelli
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Donti
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gaetano Domenico Gargiulo
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Vanreusel I, Segers VF, Van Craenenbroeck E, Van Berendoncks A. Coronary Microvascular Dysfunction in Patients with Congenital Heart Disease. Curr Cardiol Rev 2023; 19:e190123212886. [PMID: 36658708 PMCID: PMC10494268 DOI: 10.2174/1573403x19666230119112634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 01/21/2023] Open
Abstract
Congenital heart diseases represent a wide range of cardiac malformations. Medical and surgical advances have dramatically increased the survival of patients with congenital heart disease, leading to a continuously growing number of children, adolescents, and adults with congenital heart disease. Nevertheless, congenital heart disease patients have a worse prognosis compared to healthy individuals of similar age. There is substantial overlap in the pathophysiology of congenital heart disease and heart failure induced by other etiologies. Among the pathophysiological changes in heart failure, coronary microvascular dysfunction has recently emerged as a crucial modulator of disease initiation and progression. Similarly, coronary microvascular dysfunction could be important in the pathophysiology of congenital heart diseases as well. For this systematic review, studies on maximal vasodilatory capacity in the coronary microvascular bed in patients with congenital heart disease were searched using the PubMed database. To date, coronary microvascular dysfunction in congenital heart disease patients is incompletely understood because studies on this topic are rare and heterogeneous. The prevalence, extent, and pathophysiological relevance of coronary microvascular dysfunction in congenital heart diseases remain to be elucidated. Herein, we discuss what is currently known about coronary microvascular dysfunction in congenital heart disease and future directions.
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Affiliation(s)
- Inne Vanreusel
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem 2650, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Vincent F.M. Segers
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem 2650, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Emeline Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem 2650, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
| | - An Van Berendoncks
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Edegem 2650, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp 2610, Belgium
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Chaudhry A, Selwyn J, Adams E, Bradley EA. Heart Failure in Complex Congenital Heart Disease of the Adult. Curr Cardiol Rep 2022; 24:1727-1735. [PMID: 36197543 PMCID: PMC9901216 DOI: 10.1007/s11886-022-01788-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Adult congenital heart disease (ACHD) patients have demonstrated improved survival, especially those with severely complex disease, mainly single-ventricle/Fontan physiology and those with a systemic right ventricle. We describe the heart failure phenotypes of complex CHD, reversible causes for heart failure, and considerations for advanced therapy. RECENT FINDINGS While initially marketed for application to patients with acquired causes for heart failure, newer devices and technologies have started to be used in the ACHD population. After reversible causes for heart failure in CHD are addressed, it is reasonable to consider use of new device-based technologies and orthotopic heart transplant (OHT) for end-stage disease. New heart failure technology and organ transplant should carefully be considered and applied in complex ACHD, where there may be significant improvement in morbidity and mortality.
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Affiliation(s)
- Anisa Chaudhry
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Julia Selwyn
- Department of Internal Medicine, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Elizabeth Adams
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Elisa A. Bradley
- Division of Cardiovascular Medicine, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA,Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Marzullo R, Ladouceur M, Gaio G, Giordano M, Russo MG, Sarubbi B. Impact of pregnancy on natural history of systemic right ventricle in women with transposition of the great arteries. Int J Cardiol 2022; 366:20-24. [PMID: 35842002 DOI: 10.1016/j.ijcard.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 11/05/2022]
Abstract
In the recent years, the pregnancy trend among women with Congenital Heart Disease (CHD) has increased; this has leaded to a growing demand for specialized care both in mother and in children. Although pregnancy is often well tolerated, maternal CHD may affect in some cases a maladaptive hemodynamic response carrying additional risks of cardiovascular events like arrhythmias, heart failure and, in rare cases, death. The impaired utero-placental perfusion due to maternal cardiac status may result in placental dysfunction, which may be associated with fetal growth restriction, preeclampsia, premature birth and perinatal morbidity. Systemic Right Ventricle (SRV) is one of the main conditions under which pregnancy is challenging. The sub-aortic position of morphological Right Ventricle (RV) is "physiologically" predisposed to fail at the adult age and may be potentially inadequate to support the hemodynamic stress of the pregnancy. Current literature about pregnancy in women with SRV consists of small retrospective series not providing conclusive evidence about the feasibility of a successful pregnancy outcomes. In addition, the long-term effects of pregnancy on SVR are not still adequately investigated and it remains unclear if maternal complications reported are due to pregnancy or to natural history of SVR. The aim of this paper is to offer a critical review of the knowledges at regard and to provide a practice update on the risk assessment and the pregnancy management in women with SRV in order to support the decision making and to optimize outcomes in these patients.
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Affiliation(s)
- Raffaella Marzullo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
| | - Magalie Ladouceur
- Unité de cardiologie congénitale adulte, Hôpital Européen Georges-Pompidou, Centre de référence des malformations cardiaques congénitales complexes, M3C, Paris, France
| | - Gianpiero Gaio
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Mario Giordano
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Diseases Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
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Neunhaeuserer D, Battista F, Mazzucato B, Vecchiato M, Meneguzzo G, Quinto G, Niebauer J, Gasperetti A, Vida V, Di Salvo G, Varnier M, Ermolao A. Exercise Capacity and Cardiorespiratory Fitness in Children with Congenital Heart Diseases: A Proposal for an Adapted NYHA Classification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5907. [PMID: 35627448 PMCID: PMC9141857 DOI: 10.3390/ijerph19105907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To propose and evaluate an adapted NYHA classification for children with congenital heart disease (CHD) as a feasible clinical tool for classifying patients' fitness, cardiorespiratory efficiency and functional limitations during their ordinary daily activities, which are also characterized by vigorous and competitive physical exercise among peers. METHODS This cross-sectional investigation analyzed 332 patients (13.1 ± 3.01 y/o) who underwent surgical repair of CHD and performed Cardiopulmonary Exercise Testing (CPET). Patients were divided into NYHA class I, IIA and IIB by specific questioning regarding functional limitation and performance compared to peers and at strenuous intensity. Class IIA was characterized by slight exercise limitation only for strenuous/competitive activities, whereas IIB for already ordinary physical activities. These NYHA classes were compared with maximal CPET on treadmill. RESULTS Patients' exercise capacity (exercise time, METs), aerobic capacity (VO2peak) and chronotropic response were found progressively impaired when NYHA class I was compared with IIA and IIB. Indeed, ventilatory-perfusion mismatch (PETCO2, VE/VCO2) significantly worsened from NYHA class I to IIA, while no difference was found between IIA and IIB. CONCLUSION This adapted NYHA-CHD classification could allow regular functional evaluations and accurate assessments by clinicians, leading to facilitated clinical management and timely medical interventions.
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Affiliation(s)
- Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Barbara Mazzucato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Giulia Meneguzzo
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Lindhofstraße 20, 5020 Salzburg, Austria;
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Woman and Child’s Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Maurizio Varnier
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (D.N.); (B.M.); (M.V.); (G.M.); (G.Q.); (A.G.); (M.V.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35131 Padova, Italy
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Surkova E, Kovács A, Lakatos BK, Tokodi M, Fábián A, West C, Senior R, Li W. Contraction patterns of the systemic right ventricle: a three-dimensional echocardiography study. Eur Heart J Cardiovasc Imaging 2021; 23:1654-1662. [PMID: 34928339 DOI: 10.1093/ehjci/jeab272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023] Open
Abstract
AIMS To investigate contraction patterns of the systemic right ventricle (SRV) in patients with transposition of great arteries (TGA) post-atrial switch operation and with congenitally corrected transposition of great arteries (ccTGA). METHODS AND RESULTS Right ventricular (RV) volumes and ejection fraction (EF) were measured by three-dimensional echocardiography in 38 patients with the SRV (24 TGA and 14 ccTGA; mean age 45 ± 12 years, 63% male), and in 38 healthy volunteers. The RV contraction was decomposed along the longitudinal, radial, and anteroposterior directions providing longitudinal, radial, and anteroposterior EF (LEF, REF, and AEF, respectively) and their contributions to total right ventricular ejection fraction (LEFi, REFi, and AEFi, respectvely). SRV was significantly larger with lower systolic function compared with healthy controls. SRV EF and four-chamber longitudinal strain strongly correlated with B-type natriuretic peptide (BNP) level (Rho -0.73, P < 0.0001 and 0.70, P < 0.0001, respectively). In patients with TGA, anteroposterior component was significantly higher than longitudinal and radial components (AEF 17 ± 4.5% vs. REF 13 ± 4.9% vs. LEF 10 ± 3.3%, P < 0.0001; AEFi 0.48 ± 0.09 vs. REFi 0.38 ± 0.1 vs. LEFi 0.29 ± 0.08, P < 0.0001). In patients with ccTGA, there was no significant difference between three SRV components. AEFi was significantly higher in TGA subgroup compared with ccTGA (0.48 ± 0.09 vs. 0.36 ± 0.08, P = 0.0002). CONCLUSION Contraction patterns of the SRV are different in TGA and ccTGA. Anteroposterior component is dominant in TGA providing compensation for impaired longitudinal and radial components, while in ccTGA all components contribute equally to the total EF. SRV EF and longitudinal strain demonstrate strong correlation with BNP level and should be a part of routine echocardiographic assessment of the SRV.
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Affiliation(s)
- Elena Surkova
- Department of Echocardiography, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, UK
| | - Attila Kovács
- Echocardiography Core Laboratory, Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest H-1122, Hungary
| | - Bálint Károly Lakatos
- Echocardiography Core Laboratory, Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest H-1122, Hungary
| | - Márton Tokodi
- Echocardiography Core Laboratory, Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest H-1122, Hungary
| | - Alexandra Fábián
- Echocardiography Core Laboratory, Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest H-1122, Hungary
| | - Cathy West
- Department of Echocardiography, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, UK
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, UK.,National Heart Lung Institute, Imperial College of London, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
| | - Wei Li
- Department of Echocardiography, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, UK.,National Heart Lung Institute, Imperial College of London, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
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Pommier V, Bredy C, Abassi H, Huguet H, Picot MC, Pierard S, Pasquet A, Iriart X, Thambo JB, Amedro P. Reliability of echocardiographic parameters of the systemic right ventricle systolic function: A prospective multicentre study. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Zhao L, Jiang WF, Yang CX, Qiao Q, Xu YJ, Shi HY, Qiu XB, Wu SH, Yang YQ. SOX17 loss-of-function variation underlying familial congenital heart disease. Eur J Med Genet 2021; 64:104211. [PMID: 33794346 DOI: 10.1016/j.ejmg.2021.104211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/11/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023]
Abstract
As the most prevalent form of human birth defect, congenital heart disease (CHD) contributes to substantial morbidity, mortality and socioeconomic burden worldwide. Aggregating evidence has convincingly demonstrated that genetic defects exert a pivotal role in the pathogenesis of CHD, and causative mutations in multiple genes have been causally linked to CHD. Nevertheless, CHD is of pronounced genetic heterogeneity, and the genetic components underpinning CHD in the overwhelming majority of patients remain obscure. In this research, a four-generation consanguineous family suffering from CHD transmitted in an autosomal dominant mode was recruited. By whole-exome sequencing and bioinformatics analyses as well as Sanger sequencing analyses of the family members, a new heterozygous SOX17 variation, NM_022454.4: c.553G > T; p.(Glu185*), was identified to co-segregate with CHD in the family, with complete penetrance. The nonsense variation was neither detected in 310 unrelated healthy volunteers used as controls nor retrieved in such population genetics databases as the Exome Aggregation Consortium database, Genome Aggregation Database, and the Single Nucleotide Polymorphism database. Functional assays by utilizing a dual-luciferase reporter assay system unveiled that the Glu185*-mutant SOX17 protein had no transcriptional activity on its two target genes NOTCH1 and GATA4, which have been reported to cause CHD. Furthermore, the mutation abrogated the synergistic transactivation between SOX17 and NKX2.5, another established CHD-causing transcription factor. These findings firstly indicate SOX17 loss-of-function mutation predisposes to familial CHD, which adds novel insight to the molecular mechanism of CHD, implying potential implications for genetic risk appraisal and individualized prophylaxis of the family members affected with CHD.
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Affiliation(s)
- Lan Zhao
- Department of Cardiology, Yantaishan Hospital, Yantai, 264003, Shandong Province, China
| | - Wei-Feng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chen-Xi Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Qi Qiao
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Hong-Yu Shi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Shao-Hui Wu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China; Central Laboratory, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
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Surkova E, Segura T, Dimopoulos K, Bispo D, Flick C, West C, Babu-Narayan SV, Senior R, Gatzoulis MA, Li W. Systolic dysfunction of the subpulmonary left ventricle is associated with the severity of heart failure in patients with a systemic right ventricle. Int J Cardiol 2021; 324:66-71. [PMID: 32987051 DOI: 10.1016/j.ijcard.2020.09.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/27/2020] [Accepted: 09/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study aimed to assess the relation between echocardiographic parameters of subpulmonary left ventricular (LV) size and function, and the severity of heart failure in patients with a systemic right ventricle (SRV). METHODS AND RESULTS A total of 157 patients (89 post Mustard/Senning operations, 68 with congenitally corrected transposition of great arteries [ccTGA]) were included. The size and function of the SRV and subpulmonary LV were assessed on the most recent echocardiographic exam. Clinical data were collected from the electronic records. The majority (133, 84.7%) were in NYHA functional class 1-2. Median BNP concentration was 79.5[38.3-173.3] ng/l, and 100 (63.7%) patients were receiving heart failure therapy. Both LV and SRV fractional area change (FAC) differed significantly between patients with NYHA class 1-2 vs 3-4 (48[41.5-52.8]% vs 34[28.6-38.6]%, p < 0.0001 and 29.5[23-35]% vs 22[20-27]%, p < 0.0001, respectively), but LV FAC had a higher discriminative power for functional class >2 than SRV FAC (AUC 0.90, p < 0.0001 vs 0.79; p < 0.0001, respectively). A LV FAC cut-off value <39.2% had the highest accuracy in identifying patients with NYHA class 3-4 (sensitivity 83% and specificity 88%). In multivariable logistic regression analysis, LV FAC and SRV FAC independently associated to NYHA class 3-4 (OR 0.80 [95%CI 0.72-0.88], p < 0.0001 and OR 0.85 [95%CI 0.76-0.96], p = 0.007, respectively). CONCLUSIONS Subpulmonary LV systolic dysfunction is associated with NYHA functional class 3-4 in patients with ccTGA or after Mustard or Senning operation. Careful evaluation of the subpulmonary LV should be a part of the routine assessment of patients with a SRV.
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Affiliation(s)
- Elena Surkova
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom.
| | - Teresa Segura
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; University Hospital 12 de Octubre, 2ª Planta Residencia general, Madrid 28041, Spain
| | - Konstantinos Dimopoulos
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Daniela Bispo
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Caroline Flick
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Cathy West
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Sonya V Babu-Narayan
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Roxy Senior
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Michael A Gatzoulis
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Wei Li
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
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Rato J, Sousa A, Cordeiro S, Mendes M, Anjos R. Sports practice predicts better functional capacity in children and adults with Fontan circulation. Int J Cardiol 2020; 306:67-72. [DOI: 10.1016/j.ijcard.2019.11.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/14/2019] [Accepted: 11/15/2019] [Indexed: 01/09/2023]
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Impact of Sophrology on cardiopulmonary fitness in teenagers and young adults with a congenital heart disease: The SOPHROCARE study rationale, design and methods. IJC HEART & VASCULATURE 2020; 27:100489. [PMID: 32154361 PMCID: PMC7057190 DOI: 10.1016/j.ijcha.2020.100489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/21/2022]
Abstract
Background Recent advances in the field of congenital heart disease (CHD) have significantly improved the overall prognosis. Now more attention is being given to health-related quality of life (HRQoL) and promotion of physical activity. Non-invasive relaxation therapy may be effective in cardiac patients concerned with exercise-induced dyspnoea. The SOPHROCARE randomised trial aims to assess the impact of Caycedian Sophrology on cardiopulmonary fitness in adolescents and young adults with CHD. Methods The SOPHROCARE trial is a nationwide, multicentre, randomised, controlled study in CHD patients aged from 13 to 25 years old. Patients will be randomised into 2 groups (8 Sophrology group sessions vs. no intervention). The primary outcome is the change in percent predicted maximum oxygen uptake (VO2max) between baseline and 12-month follow-up. A total of 94 patients in each group is required to observe a significant increase of 10% in VO2max with a power of 80% and an alpha risk of 5%. The secondary outcomes are: clinical outcomes, cardiopulmonary exercise test parameters (VE/VCO2 slope, ventilatory anaerobic threshold, oxygen pulse, respiratory response to hypercapnia), health-related quality of life score (PedsQL), physical and psychological status. Conclusion After focusing on the survival in CHD, current research is opening on secondary prevention and patient-related outcomes. We sought to assess in the SOPHROCARE trial, if a Sophrology program, could improve exercise capacity and quality of life in youth with CHD. Trial registration Clinicaltrials.gov (NCT03999320).
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