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Maximal versus sub-maximal effort during cardiopulmonary exercise testing in adults with congenital heart disease: outcome analysis of short-term cardiac-related events

Published online by Cambridge University Press:  19 October 2020

Bibhuti B. Das Open the ORCID record for Bibhuti B. Das [Opens in a new window] ,
Aliana Godoy ,
Talya Kadish  and
Jianli Niu
Bibhuti B. Das*
Affiliation:
Office of Human Research, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FL, USA Baylor College of Medicine, Texas Children’s Hospital Austin Specialty Care, Austin, TX, USA
Aliana Godoy
Affiliation:
Office of Human Research, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FL, USA
Talya Kadish
Affiliation:
Office of Human Research, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FL, USA
Jianli Niu
Affiliation:
Office of Human Research, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FL, USA
*
Author for correspondence: Bibhuti B. Das, MD, FAAP, FACC, Department of Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Austin Specialty Care, Austin, TX78759, USA. Tel: +1 737 220 8328; Fax: +1 737 220 8180. E-mail: bdas99@hotmail.com
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Abstract

Peak respiratory exchange ratio is an objective marker of patient effort during cardiopulmonary exercise testing. We evaluated exercise variables in 175 adult congenital heart disease patients and the impact of respiratory exchange ratio on the prognostic value of exercise variables for short-term cardiac-related events. Of 175 patients, 110 completed the exercise test with a peak respiratory exchange ratio of ≥1.10 and the remaining 65 had a peak respiratory exchange ratio of <1.10. Peak oxygen consumption, the percentage of oxygen consumption at the ventilatory threshold, peak heart rate, percentage predicted peak heart rate, double product, oxygen uptake efficiency slope, and the number of patients with exercise oscillatory ventilation were reduced significantly in patients with a respiratory exchange ratio of <1.10 compared to those with a respiratory exchange ratio of ≥1.10. After a median follow-up of 21 months, total cardiac-related events occurred in 37 (21%) patients. Multivariate Cox proportional hazard analysis showed that the percentage predicted peak oxygen consumption, and oxygen uptake efficiency slope were independent predictors of cardiac-related events only in patients with a peak respiratory exchange ratio of ≥1.10. Sub-maximal exercise performance can be preserved in adult congenital heart disease patients. The percentage predicted oxygen consumption and the oxygen uptake efficiency slope are two independent predictors for short-term cardiac-related events in adult congenital heart disease patients.

Keywords

Cardiopulmonary exercise testpeak respiratory exchange ratioadult congenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 1 , January 2021 , pp. 91 - 96
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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