{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T10:47:41Z","timestamp":1787827661838,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Correction of tetralogy of Fallot (cTOF) often results in pulmonary valve pathology and right ventricular (RV) dysfunction. Reduced exercise capacity in cTOF patients cannot be explained by these findings alone. We aimed to explore why cTOF patients exhibit impaired exercise capacity with the aid of a comprehensive cardiopulmonary exercise testing (CPET) and real-time cardiovascular magnetic resonance exercise testing (CMR-ET) protocol.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>\n              Thirty three cTOF patients and 35 matched healthy controls underwent CPET and CMR-ET in a prospective case-control study. Real-time steady-state free precession cine and phase-contrast sequences were obtained during incremental supine in-scanner cycling at 50, 70, and 90 W. RV and left ventricle (LV) volumes and pulmonary blood flow (Qp) were calculated. Differences of CPET and CMR-ET between cTOF versus controls and correlations between CPET and CMR-ET parameters in cTOF were evaluated statistically for all CMR exercise levels using Mann-Whitney\n              <jats:italic toggle=\"yes\">U<\/jats:italic>\n              and Spearman rank-order correlation tests.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              CPET capacity was significantly lower in cTOF than in controls. cTOF patients exhibited not only significantly reduced Qp and RV function but also lower LV function on CMR-ET. Higher CPET values in cTOF correlated with higher Qp (Qp 90 W versus carbon dioxide ventilatory equivalent %:\n              <jats:italic toggle=\"yes\">R<\/jats:italic>\n              =\u22120.519,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05), higher LV\u2013end-diastolic volume indexed to body surface area (LV\u2013end-diastolic volume indexed to body surface area at 50 W versus oxygen uptake in % at maximum exercise on CPET\n              <jats:italic toggle=\"yes\">R<\/jats:italic>\n              =0.452,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05), and change in LV ejection fraction (EF; LV-EF at 90 W versus Watt %:\n              <jats:italic toggle=\"yes\">r<\/jats:italic>\n              =\u22120.463,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05). No correlation was found with regard to RV-EF. Significant RV-LV interaction was observed during CMR-ET (RV-EF versus LV-EF at 50 W and 70 W:\n              <jats:italic toggle=\"yes\">r<\/jats:italic>\n              =0.66,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.02 and\n              <jats:italic toggle=\"yes\">r<\/jats:italic>\n              =0.52,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05, respectively).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Impaired exercise capacity in cTOF resulted from a reduction in not only RV, but also LV function. cTOF with good exercise capacity on CPET demonstrated higher LV reserve and pulmonary blood flow during incremental CMR-ET. Apart from RV parameters, CMR-ET\u2013derived LV function could be a valuable tool to stratify cTOF patients for pulmonary valve replacement.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.120.011823","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T05:00:55Z","timestamp":1628830855000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Impaired Exercise Tolerance in Repaired Tetralogy of Fallot Is Associated With Impaired Biventricular Contractile Reserve: An Exercise-Stress Real-Time Cardiovascular Magnetic Resonance Study"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5541-1147","authenticated-orcid":true,"given":"Michael","family":"Steinmetz","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.)"},{"name":"DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"St\u00fcmpfig","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.)"},{"name":"DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Seehase","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Schuster","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology (A.S., C.U.-B.)"},{"name":"DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Kowallick","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.)"},{"name":"DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Unterberg-Buchwald","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology (A.S., C.U.-B.)"},{"name":"Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.)"},{"name":"DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby","family":"Kutty","sequence":"additional","affiliation":[{"name":"University Medical Center, Georg-August-University, Goettingen, Germany. The Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Lotz","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.)"},{"name":"DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8850-809X","authenticated-orcid":true,"given":"Martin","family":"Uecker","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.)"},{"name":"DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. 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