Thorac Cardiovasc Surg 2014; 62 - p5
DOI: 10.1055/s-0034-1394028

Determinants of Exercise Capacity in Patients with Ebstein’s Anomaly: Is it all about the Left Ventricle?

T. Rutz 1, A. Kühn 1, J. Müller 1, C. Meierhofer 1, A. Hager 1, S. Fratz 1, P. Wolf 2, I. C. Rondak 2, P. Ewert 1, M. Vogt 1
  • 1Klinik für Kinderkardiologie und angeborene Herzerkrankungen, Deutsches Herzzentrum München, Technische Universität, München
  • 2Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität, München

Background: Ebstein’s anomaly (EA) has a variable morphological presentation causing a diminished exercise capacity. This study aims by a comprehensive evaluation with modern imaging techniques and clinical parameters identification of determinants of exercise capacity.

Methods: Forty-five consecutive patients (median age 31 years, [6-69] underwent cardiac magnetic resonance imaging, transthoracic echocardiography, chest X-ray and ECG. A cardiopulmonary exercise test with determination of the maximum oxygen uptake (peak VO2) was performed in all patients.

Results: Randomforest analyses revealed the following parameters as most important determinants of peak VO2 (order by decreasing relevance, in brackets linear correlation coefficient): early diastolic velocity of lateral mitral annulus (r2=0.22, p=0.02), left ventricular (LV) enddiastolic diameter (r2=0.11, p=0.03), ratio of early transmitral flow velocity to early diastolic velocity of the lateral mitral annulus (r2=0.12, p=0.024), LV stroke volume index (r2=0.09, p=0.044), oxygen saturation at peak exercise (r2=0.11, p=0.025), peak systolic velocity of mitral annulus (r2=0.09, p=0.05), right ventricular (RV) ejection fraction (r2=0.08, p=0.065), RV stroke volume index (r2=0.03, p=0.274), early diastolic velocity of tricuspid annulus (r2=0.11, p=0.056).

Conclusions: EA causes a diminished LV preload leading to LV systolic and diastolic dysfunction responsible for a diminished exercise capacity. Atrial right to left shunting and RV function parameters play a less important role.