{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:27:38Z","timestamp":1790396858111,"version":"4.1.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,1,22]]},"abstract":"\n Background<\/jats:title>\n \n The relative impact of right ventricular (\n RV<\/jats:styled-content>\n ) electromechanical dyssynchrony versus pulmonary regurgitation (\n PR<\/jats:styled-content>\n ) on exercise capacity and\n RV<\/jats:styled-content>\n function after tetralogy of Fallot repair is unknown. We aimed to delineate the relative effects of these factors on\n RV<\/jats:styled-content>\n function and exercise capacity.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We retrospectively analyzed 81 children with tetralogy of Fallot repair using multivariable regression. Predictor parameters were electrocardiographic\n QRS<\/jats:styled-content>\n duration reflecting electromechanical dyssynchrony and\n PR<\/jats:styled-content>\n severity by cardiac magnetic resonance. The outcome parameters were exercise capacity (percentage predicted peak oxygen consumption) and cardiac magnetic resonance ejection fraction (RV ejection fraction). To understand the relative effects of\n RV<\/jats:styled-content>\n dyssynchrony versus\n PR<\/jats:styled-content>\n on exercise capacity and\n RV<\/jats:styled-content>\n function, virtual patient simulations were performed using a closed\u2010loop cardiovascular system model (CircAdapt), covering a wide spectrum of disease severity. Eighty\u2010one patients with tetralogy of Fallot repair (median [interquartile range {\n IQR}<\/jats:styled-content>\n ] age, 14.48 [11.55\u201315.91] years) were analyzed. All had prolonged\n QRS<\/jats:styled-content>\n duration (median [IQR], 144 [123\u2013152] ms), at least moderate\n PR<\/jats:styled-content>\n (median [IQR], 40% [29%\u201348%]), reduced exercise capacity (median [IQR], 79% [68%\u201392%] predicted peak oxygen consumption), and reduced\n RV<\/jats:styled-content>\n ejection fraction (median [IQR], 48% [44%\u201352%]). Longer\n QRS<\/jats:styled-content>\n duration, more than\n PR<\/jats:styled-content>\n , was associated with lower oxygen consumption and lower RV ejection fraction. In a multivariable regression analysis, oxygen consumption decreased with both increasing\n QRS<\/jats:styled-content>\n duration and\n PR<\/jats:styled-content>\n severity. CircAdapt modeling showed that\n RV<\/jats:styled-content>\n dyssynchrony exerts a stronger limiting effect on exercise capacity and on\n RV<\/jats:styled-content>\n ejection fraction than does\n PR<\/jats:styled-content>\n , regardless of contractile function.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In both patient data and computer simulations,\n RV<\/jats:styled-content>\n dyssynchrony, more than\n PR<\/jats:styled-content>\n , appears to be associated with reduced exercise capacity and\n RV<\/jats:styled-content>\n systolic dysfunction in patients after\n TOF<\/jats:styled-content>\n repair.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.010903","type":"journal-article","created":{"date-parts":[[2019,1,17]],"date-time":"2019-01-17T10:00:43Z","timestamp":1547719243000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":52,"title":["Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation on Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot"],"prefix":"10.1161","volume":"8","author":[{"given":"Joost","family":"Lumens","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands"},{"name":"IHU LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Universit\u00e9 Pessac France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Po Steve","family":"Fan","sequence":"additional","affiliation":[{"name":"Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Walmsley","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deane","family":"Yim","sequence":"additional","affiliation":[{"name":"Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cedric","family":"Manlhiot","sequence":"additional","affiliation":[{"name":"Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Dragulescu","sequence":"additional","affiliation":[{"name":"Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Grosse\u2010Wortmann","sequence":"additional","affiliation":[{"name":"Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Mertens","sequence":"additional","affiliation":[{"name":"Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits W.","family":"Prinzen","sequence":"additional","affiliation":[{"name":"Department of Physiology Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammo","family":"Delhaas","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark K.","family":"Friedberg","sequence":"additional","affiliation":[{"name":"Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario 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