Diastolic and systolic cardiac dysfunction in pectus excavatum: Relationship to exercise and malformation severity

Abstract

Purpose: To explore stress echocardiographic findings among patients with pectus excavatum (PEX) and their relationship with malformation severity. Materials and Methods: A prospective registry involving consecutive patients with a diagnosis of isolated PEX referred to undergo chest CT and stress echocardiography to evaluate surgical candidacy and/or to define treatment strategies was developed. Malformation indexes were evaluated using chest CT. Results: This study included 269 patients with PEX (19.7 years 6 7.8 [standard deviation]; 245 men) and 35 healthy volunteers (20.7 years 6 6.1; 21 men). Patients with PEX achieved a lower maximal workload (PEX group, 8.2 metabolic equivalents 6 1.7; control group, 11.8 metabolic equivalents 6 5.5; P, .0001). This study identified evidence of abnormal right ventricular diastolic function in 29% of patients with PEX and identified no evidence of this among those in the control group (P, .0001). Healthy controls showed a 37% increment in the tricuspid area during exercise, compared with 4% in patients with PEX (P = .002). Right ventricular systolic function was significantly lower in patients with PEX than in controls, both measured using tricuspid annulus plane systolic excursion (stress, 25.0 mm 6 5.5 vs 35.4 mm 6 3.7; P, .0001), and the tricuspid systolic wave was also smaller (stress, 16.9 cm/sec 6 4.5 vs 20.5 cm/sec 6 3.9; P, .0001). During stress, significant associations were detected between malformation indexes with right ventricular systolic and diastolic findings (P, .05 for all). Conclusion: This study identified evidence of diverse adverse functional and morphologic cardiac manifestations in PEX, involving signs of abnormal diastolic and systolic right ventricular function and compression of the atrioventricular groove, which worsened during stress and were related to malformation severity.