BACKGROUND Pulmonary insufficiency (PI) and right ventricular (RV) dysfunction are long-term complications in patients with repaired tetralogy of Fallot (rTOF). The aim of this study was to investigate RV contractile reserve and changes in PI that occur during exercise in patients with rTOF and the associations of these changes with exercise performance using stress echocardiography. METHODS Subjects with rTOF (n = 32) and healthy control subjects (n = 10) were prospectively enrolled and underwent rest and peak exercise echocardiography during standard cardiopulmonary exercise test protocol on a cycle ergometer or treadmill. RV contractile reserve was defined as the change in RV global longitudinal strain from rest to peak exercise. PI was assessed with the diastolic-to-systolic time-velocity integral ratio and diastolic/systolic velocity ratio from pulmonary artery Doppler interrogation. Exercise measures included heart rate reserve, percentage predicted maximum oxygen consumption, percentage predicted maximum work, and oxygen pulse. RESULTS RV contractile reserve was impaired in patients with rTOF compared with control subjects, with a significant drop in the absolute value of RV global longitudinal strain from 17% (range, 8%-27%) at rest to 13% (range, 5%-28%) at peak exercise. Similarly, PI decreased at peak exercise, with decreases in diastolic-to-systolic time-velocity integral and diastolic/systolic velocity ratios. Reduction in PI was directly associated with percentage predicted maximum oxygen consumption, percentage predicted maximum work, and greater oxygen pulse. Heart rate reserve was directly associated with percentage predicted maximum oxygen consumption and percentage predicted maximum work. RV contractile reserve was not associated with any exercise parameters. CONCLUSIONS Patients with rTOF have an abnormal myocardial response to exercise with impaired RV contractile reserve compared with control subjects. Heart rate reserve and reduction in PI at peak exercise are associated with better exercise performance and appear to be significant contributors to exercise performance in rTOF. Measures to improve chronotropic health in rTOF should be explored.

中文翻译：

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儿童和青少年的法洛四联症修复后右心室收缩储备受损：一项运动应变成像研究。

背景技术肺功能不全（PI）和右心室（RV）功能障碍是法洛四联症（rTOF）修复后的患者的长期并发症。这项研究的目的是利用应力超声心动图调查rTOF患者运动期间RV收缩储备和PI的变化，以及这些变化与运动表现的相关性。方法前瞻性纳入rTOF受试者（n = 32）和健康对照受试者（n = 10），并在标准的心肺运动测试方案上，在脚踏测力计或跑步机上进行休息和峰值运动超声心动图检查。RV收缩储备定义为RV整体纵向应变从休息到运动高峰的变化。用肺动脉多普勒询问的舒张期与收缩期时间速度积分比和舒张期/收缩期速度比评估PI。运动量度包括心律储备，预计最大耗氧量百分比，预计最大工作量百分比和氧气脉搏。结果与对照组相比，rTOF患者的RV收缩储备受损，RV总体纵向应变的绝对值从静止时的17％（范围8％-27％）显着下降至13％（范围5％） -28％）。同样，PI在运动高峰时下降，舒张期与收缩期的时间速度积分和舒张期/收缩期的速速比降低。PI的降低与预计最大耗氧量百分比，预计最大功耗百分比和更大的氧气脉冲直接相关。心率储备与预测最大耗氧量百分比和预测最大工作量百分比直接相关。右室收缩储备与任何运动参数无关。结论与对照组相比，rTOF患者的运动对心肌的反应异常，RV收缩储备受损。运动高峰期的心率储备和PI降低与更好的运动表现有关，并且似乎是rTOF运动表现的重要贡献者。应该探索改善rTOF中变时性健康的措施。结论与对照组相比，rTOF患者的运动对心肌的反应异常，RV收缩储备受损。运动高峰期的心率储备和PI降低与更好的运动表现有关，并且似乎是rTOF运动表现的重要贡献者。应该探讨改善rTOF中变时性健康的措施。结论与对照组相比，rTOF患者的运动对心肌的反应异常，RV收缩储备受损。运动高峰期的心率储备和PI降低与更好的运动表现有关，并且似乎是rTOF运动表现的重要贡献者。应该探讨改善rTOF中变时性健康的措施。