ORIGINAL ARTICLE Right ventricular contractile reserve in tetralogy of Fallot patients with pulmonary regurgitation Clotilde Kingsley MBBS 1 | Saad Ahmad MD 2 | John Pappachan MA, MB, BChir, FRCA, MBBS, PhD 1 | Sujata Khambekar MBBS, FRCP, MBBS, PhD 1 | Thomas Smith BSc, MBBS, PhD 1 | Diane Gardiner BSc, MBBS, PhD 1 | James Shambrook MBBS, FRCR 1 | Shankar Baskar MD 3 | Ryan Moore MD 3 | Gruschen Veldtman MBChB, FRCP 3 1 Department of Congenital Heart Disease, Southampton University Hospital, Wessex Cardiothoracic Centre, Southampton, UK 2 Division of Cardiovascular Health and Diseases, University of Cincinnati, Cincinnati, Ohio, USA 3 Heart Institute Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA Correspondence Gruschen R Veldtman, Adolescent and Adult Congenital Program, Heart Institute Cincinnati Children’s Hospital Medical Centre, 3333 Burnet Avenue, Cincinnati, Ohio 45229, USA. Email: Gruschen.veldtman@cchmc.org Abstract Background: The right ventricular (RV) contractile reserve is a measure of the dynamic function of the RV and is a sensitive indicator of volume load. This can be measured noninvasively using the tricuspid annular plane systolic excursion (TAPSE) during exercise. We studied the RV contractile reserve of patients after tetralogy of Fallot (TOF) repair with varying degree of RV dilation and pul- monary regurgitation (PR), and compared them to a control group. Methods: Twenty-six patients who had undergone TOF repair (mean age 29 6 10 years) were identified and stratified into three group based on the presence and severity of RV dilation and PR. We recruited 13 age- and sex-matched controls with normal cardiac anatomy for comparison. After obtaining a baseline echocardiogram in the resting state, patients underwent exercise testing on a treadmill utilizing Bruce protocol. At maximal voluntary ability during the exercise testing, the patient was immediately laid down on an echocardiography couch, and a peak exercise echocardio- gram was obtained. Results: TOF patients, regardless of RV size and PR severity, had significantly shorter exercise duration (685 vs 802 s, P 5 .02), lower TAPSE at rest (1.7 vs 2.3 cm, P < 0.001) and at peak exer- cise (1.6 6 0.4 vs 2.6 6 0.5 cm P < .001) when compared to the control group. Patients with RV dilation were more likely to have worse RV contractile reserve but increased TAPSE and tricuspid annular acceleration at rest when compared to patients without RV dilation. Conclusions: TOF patients with dilated RV and PR have worse RV function at rest and during exercise, compared to TOF subjects without RV dilation. Long-axis RV contractile reserve as assessed by TAPSE, was lower in TOF subjects versus controls, and was worse in those with signif- icant RV dilation, suggesting a decline in contractile reserve with an increase in RV volume. KEYWORDS contractile reserve, pulmonary valve replacement, timing, tricuspid annular plane systolic excursion ABBREVIATIONS: EF, ejection fraction; LV, left ventricle; MAPSE, mitral annular plane systolic excursion; MR, magnetic resonance; PR, pulmonary regurgitation; PVR, pulmonary valve replacement; RV, right ventricle; RVEDV, right ventricular end-diastolic volume; RVESV, right ventricular end-systolic volume; RVOT, right ventricular outflow tract; TAPSE, tricuspid annular plane systolic excursion; TOF, tetralogy of Fallot. Congenital Heart Disease. 2018;1–7. wileyonlinelibrary.com/journal/chd V C 2018 Wiley Periodicals, Inc. | 1 Received: 5 August 2017 | Revised: 2 November 2017 | Accepted: 8 December 2017 DOI: 10.1111/chd.12569