Exercise stress CMR reveals reduced aortic distensibility and impaired right-ventricular adaptation to exercise in patients with repaired tetralogy of Fallot

{Background The aim of our study was to evaluate the feasibility of exercise cardiac magnetic resonance (CMR) in patients with repaired tetralogy of Fallot (RTOF) and to assess right and left ventricular adaptation and aortic wall response to exercise in comparison with volunteers. Methods 11 RTOF and 11 volunteers underwent prospective CMR at rest and during exercise. A supine bicycle ergometer was employed to reach twice the resting heart rate during continuous exercise, blood pressure and heart rate were recorded. Bi-ventricular parameters and aortic stiffness were assessed using accelerated cine sequences and flow-encoding CMR. A t-test was used to compare values between groups. A Mann Whitney test was used to compare values within groups. Results In RTOF both ventricles showed an impaired contractile reserve (RVEF rest 36.2 +/- 8.3%, +1.3 +/- 3.9% increase after exercise; LVEF rest 53.8 +/- 6.1%, +5.7 +/- 6.4% increase after exercise) compared to volunteers (RVEF rest 50.5 +/- 5.0%, +10.4 +/- 7.1% increase after exercise