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Natural History of Exercise Function in Patients With Ebstein Anomaly: A Serial Study
Study Questions:
What is the natural history of exercise function in patients with Ebstein anomaly?
Methods:
A retrospective review of 23 patients was performed at a single center. Patients were excluded from the study if they had previously undergone tricuspid valve surgery. Exercise testing was performed with either an individualized ramp protocol using a stationary cycle ergometer, or a treadmill using the standard Bruce protocol.
Results:
The median age at first exercise test was 17.9 (range, 8.1-52.5 years), with median interval between tests of 3.3 (range, 0.6-7.3 years). The percentage of predicted peak oxygen consumption declined at a rate of 1.87 ± 8.04 percentage points per year. The decline was most pronounced in patients <18 years old, for whom the decline was 3.04 ± 6.78 percentage points.
Conclusions:
The authors concluded that exercise function of patients with Ebstein anomaly tends to deteriorate with time.
Perspective:
This small study suggests a decrease in exercise capacity over time in patients with unrepaired Ebstein anomaly. Interestingly, the majority of the decline was seen in younger patients. There was no statistically significant decline in exercise capacity in patients >18 years. The primary limitations of this study are the small sample size and the heterogeneity of Ebstein anomaly. It is therefore difficult to either generalize these results to an individual patient, or to make decisions regarding timing of operative intervention.
Keywords: Exercise Tolerance, Tricuspid Valve, Heart Defects, Congenital, Oxygen Consumption, Cardiology, Exercise, Communism, Ebstein Anomaly, Exercise Test
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