Abstract 3128: Percutaneous Pulmonary Valve Implantation Improves Exercise Capacity In Patients With Predominantly Stenosis But Not In Predominantly Regurgitation
Background: Improvement in left ventricular stroke volume after percutaneous pulmonary valve implantation (PPVI) for relief of right ventricular volume or pressure overload has been demonstrated before. In this study, we sought to determine whether these changes are reflected in the parameters of maximal exercise capacity.
Methods: Cardiopulmonary exercise testing and measurement of peak VO2 was performed prior to and after PPVI in 99 patients. In addition, we performed subgroup analyses: Group 1 - predominately pulmonary stenosis (echo gradient > 50mmHg); Group 2 - predominately pulmonary regurgitation (PR) (>20% pulmonary regurgitation fraction on magnetic resonance). Patients who met both criteria were excluded form subgroup analyses.
Results: After PPVI, peak VO2 improved significantly in the total population (23.4±7.1 25.6±7.2 ml/kg/min, p<0.001). On subgroup analysis, increase in peak VO2 was only seen in the stenotic group, whereas patients with PR had no significant change in peak VO2 (23.5±7.9 to 24.2±7.0 ml/kg/min, p=0.9). Interestingly, even in the predominantly regurgitant group degree of relief of stenosis correlated with improvement in exercise capacity (Figure⇓).
Conclusion: Relief of RV afterload improves exercise capacity. In contrast, abolishment of PR does not seem to be reflected in peak exercise performance. This reflects the different impact of regurgitant and stenotic lesions on functional performance and suggests an early intervention for pulmonary regurgitation.