Document Detail

Comprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term.
MedLine Citation:
PMID:  22147905     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Parameters of cardiopulmonary exercise testing were recently identified as strong predictors of mortality in adults with congenital heart disease. We hypothesized that combinations of cardiopulmonary exercise testing parameters may provide optimal prognostic information on midterm survival in this population.
METHODS AND RESULTS: A total of 1375 consecutive adult patients with congenital heart disease (age, 33±13 years) underwent cardiopulmonary exercise testing at a single center over a period of 10 years. Peak oxygen consumption (peak V(O(2))), ventilation per unit of carbon dioxide production (V(E)/V(O(2)) slope), and heart rate reserve were measured. During a median follow-up of 5.8 years, 117 patients died. Peak V(O(2)), heart rate reserve, and V(E)/V(O(2)) slope were related to midterm survival in adult patients with congenital heart disease. Risk of death increased with lower peak V(O(2)) and heart rate reserve. A higher V(E)/V(O(2)) slope was also related to increased risk of death in noncyanotic patients, whereas the V(E)/V(O(2)) slope was not predictive of mortality in cyanotic patients. The combination of peak V(O(2)) and heart rate reserve provided the greatest predictive information after adjustment for clinical parameters such as negative chronotropic agents, age, and presence of cyanosis. However, the incremental value of these exercise parameters was reduced in patients with peak respiratory exchange ratio <1.0.
CONCLUSIONS: Cardiopulmonary exercise testing provides strong prognostic information in adult patients with congenital heart disease. Prognostication should be approached differently, depending on the presence of cyanosis, use of rate-lowering medications, and achieved level of exercise. We provide 5-year survival prospects based on cardiopulmonary exercise testing parameters in this growing population.
Ryo Inuzuka; Gerhard-Paul Diller; Francesco Borgia; Leah Benson; Edgar L W Tay; Rafael Alonso-Gonzalez; Margarida Silva; Menelaos Charalambides; Lorna Swan; Konstantinos Dimopoulos; Michael A Gatzoulis
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-12-06
Journal Detail:
Title:  Circulation     Volume:  125     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-17     Completed Date:  2012-04-12     Revised Date:  2012-10-16    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  250-9     Citation Subset:  AIM; IM    
Copyright Information:
© 2011 American Heart Association, Inc.
Adult Congenital Heart Centre & Centre for Pulmonary Hypertension/NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney St, SW3 6NP, London, UK.
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MeSH Terms
Exercise Test / methods*
Heart Defects, Congenital / diagnosis*,  mortality,  physiopathology
Heart Function Tests
Heart Rate
Middle Aged
Oxygen Consumption
Pulmonary Ventilation
Respiratory Function Tests
Retrospective Studies
Survival Analysis
Grant Support
//British Heart Foundation
Comment In:
Circulation. 2012 Jan 17;125(2):210-1   [PMID:  22147906 ]
Circulation. 2012 Aug 21;126(8):e122; author reply e123   [PMID:  22908022 ]

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