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Non-invasive Hemodynamic CMR Parameters Predicting Maximal Exercise Capacity in 54 Patients with Ebstein’s Anomaly

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Abstract

Background

Exercise capacity is a well-defined marker of outcome in congenital heart disease. We analyzed seventeen cardiovascular magnetic resonance (CMR) derived parameters and their correlation to exercise capacity in patients with Ebstein’s anomaly (EA).

Methods

Fifty-four surgery free patients, age 5 to 69 years (median 30 years) prospectively underwent CMR examination and cardiopulmonary exercise testing (CPET). The following volume/flow parameters were compared with peak oxygen uptake as the percentage of normal (peakVO2%) using univariate and multivariate analysis: right and left ventricular ejection fraction (RVEF and LVEF), the indexed end-diastolic and end-systolic volumes (RVEDVi, RVESVi, LVEDVi, and LVESVi), the indexed stroke volumes (RVSVi and LVSVi), the total normalized right and left heart volumes; the total right to left heart volume ratio (R/L-ratio). The indexed antegrade flow (ante), indexed net flow (net) as well as cardiac index (CI) in the aorta (Ao) and pulmonary artery (PA) were used.

Results

RVEF (R2 0.2788), indexed flow PA net (R2 0.2330), and PA ante (R2 0.1912) showed the best correlation with peakVO2% (all p < 0.001) in the univariate model. Further significant correlation could also be demonstrated with CI-PA, LVEF, LVSVi, Aorta net, RVESVi, and Aorta ante. Multivariate analysis for RVEF and indexed net flow PA revealed a R2 of 0.4350.

Conclusion

Functional CMR parameters as RVEF and LVEF and flow data of cardiac forward flow correlate to peakVO2%. Evaluation of the indexed net flow in the pulmonary artery and the overall function of the right ventricle best predicts the maximal exercise capacity in patients with EA.

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Author notes

  1. Christian Meierhofer and Andreas Kühn have contributed equally to this manuscript.

Authors and Affiliations

  1. Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technical University of Munich, Lazarettstrasse 36, 80636, Munich, Germany

    Christian Meierhofer, Andreas Kühn, Jan Müller, Nerejda Shehu, Alfred Hager, Heiko Stern, Peter Ewert & Manfred Vogt

  2. Radiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany

    Stefan Martinoff

  3. Kinderherzpraxis München, Munich, Germany

    Manfred Vogt

Authors
  1. Christian Meierhofer
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  2. Andreas Kühn
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  3. Jan Müller
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  4. Nerejda Shehu
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  5. Alfred Hager
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  7. Heiko Stern
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  8. Peter Ewert
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Correspondence to Christian Meierhofer.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethical Committee of the Technical University of Munich.

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Informed consent was obtained from all individual participants included in the study.

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Meierhofer, C., Kühn, A., Müller, J. et al. Non-invasive Hemodynamic CMR Parameters Predicting Maximal Exercise Capacity in 54 Patients with Ebstein’s Anomaly. Pediatr Cardiol 40, 792–798 (2019). https://doi.org/10.1007/s00246-019-02066-7

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  • DOI: https://doi.org/10.1007/s00246-019-02066-7

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