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

Das, Bibhuti B.; Godoy, Aliana; Kadish, Talya; Niu, Jianli

doi:10.1017/s104795112000339x

Cited by 5 publications

(3 citation statements)

References 37 publications

(44 reference statements)

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“…Cardiopulmonary exercise testing (CPET) might help to determine functional capacity and has a predictive value for outcome in sicker patients (10). The same is true for the use of biomarkers (9).…”

Section: Introductionmentioning

confidence: 99%

Adverse functional remodelling of the subpulmonary left ventricle in patients with a systemic right ventricle is associated with clinical outcome

Santens

Helsen

Bruaene

et al. 2021

European Heart Journal - Cardiovascular Imaging

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Aims Early recognition of adverse remodelling is important since outcome is unfavorable once patients with a systemic right ventricle (sRV) become symptomatic. We aimed assessing prognostic markers linked to short-term clinical evolution in this population. Methods and results Thirty-three patients (76% male) with sRV (atrial switch repair for D-transposition of the great arteries and congenitally corrected transposition of the great arteries) underwent detailed phenotyping including exercise cardiac magnetic resonance and were followed over mean follow-up time of 3 years. Mean age was 40 ± 8 (range 26–57) years at latest follow-up. Adverse outcome was a composite of heart failure (HF) and tachyarrhythmia. Descriptive statistics and univariate cox regression analyses were performed. When compared with baseline: (i) most patients remained in New York Heart Association functional class I (76%), (ii) the degree of severity of the systemic atrioventricular valve regurgitation rose, and (iii) more electrical instability was documented at latest follow-up. Six (18%) of a total of 9 events were counted as first cardiovascular events (9% HF and 9% arrhythmia). NT-proBNP, oxygen pulse, left ventricle end-diastolic volume index (LVEDVi), and stroke volume index (SVi) of the subpulmonary left ventricle (LV) both in rest and at peak exercise were significantly associated with the first cardiovascular event. Conclusion NT-proBNP was by far the best prognostic marker for clinical outcome. Adverse remodelling with increase of LVEDVi and SVi of the subpulmonary LV at rest and during exercise were associated with worse clinical outcome. We theorize that remodelling of the subpulmonary ventricle might be an early sign of a failing sRV circulation.

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Section: Introductionmentioning

confidence: 99%

Adverse functional remodelling of the subpulmonary left ventricle in patients with a systemic right ventricle is associated with clinical outcome

Santens

Helsen

Bruaene

et al. 2021

European Heart Journal - Cardiovascular Imaging

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show abstract

“…CPET might help to determine functional capacity and has a predictive value for adverse outcomes in adults with CHD [85]. Among CPET parameters that showed a strong association with adverse cardiac events, there are the indexed oxygen uptake efficiency slope (OUES) [82], VO2, and VE/VCO2 [86] These results have the potential to become a useful clinical tool for surveillance of this high-risk patient population.…”

Section: Functional Class and Exercise Capacitymentioning

confidence: 99%

Overview of Long-Term Outcome in Adults with Systemic Right Ventricle and Transposition of the Great Arteries: A Review

et al. 2023

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The population of patients with a systemic right ventricle (sRV) in biventricular circulation includes those who have undergone an atrial switch operation for destro-transposition of the great arteries (d-TGA) and those with congenitally corrected transposition of the great arteries (ccTGA). Despite the life expectancy of these patients is significantly increased, the long-term prognosis remains suboptimal due to late complications such as heart failure, arrhythmias, and premature death. These patients, therefore, need a close follow-up to early identify predictive factors of adverse outcomes and to implement all preventive therapeutic strategies. This review analyzes the late complications of adult patients with an sRV and TGA and clarifies which are risk factors for adverse prognosis and which are the therapeutic strategies that improve the long-term outcomes. For prognostic purposes, it is necessary to monitor sRV size and function, the tricuspid valve regurgitation, the functional class, the occurrence of syncope, the QRS duration, N-terminal pro B-type natriuretic peptide levels, and the development of arrhythmias. Furthermore, pregnancy should be discouraged in women with risk factors. Tricuspid valve replacement/repair, biventricular pacing, and implantable cardioverter defibrillator are the most important therapeutic strategies that have been shown, when used correctly, to improve long-term outcomes.

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“…In recent decades, other measures from an exercise test have been associated with prognosis, such as chronotropic response (Cole et al, 1999;Morshedi-Meibodi et al, 2002), oxygen uptake efficiency (Das et al, 2020), and VĖ/VĊO 2 (Sayegh et al, 2020). These measures in addition to a simple VȮ 2peak are invaluable, especially in clinical practice where patients rarely achieve a true maximum.…”

Section: Alternative Outcome Measures Of a Cardiopulmonary Stress Testmentioning

confidence: 99%

Exercise testing in cardiovascular disease

Sprung¹,

Buckley²,

Oxborough³

2022

Sport and Exercise Physiology Testing Guidelines

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INTRODUCTIONCardiovascular disease (CVD) provides one of the biggest challenges to exercise and health professionals in the United Kingdom (UK), and Worldwide. This is primarily due to the scale of the problem as well as the diversity and complexity of these diseases. It is well known that CVD is the most common pathology in 'Westernised' societies. The British Heart Foundation data compendium, published in April 2020, detailed that 7.6 million people live with CVD in the UK. In terms of mortality rate, CVD accounted for ~163,000 deaths in the UK which represented 27% of all deaths and ~43,000 of which were deemed premature (recorded in individuals under 75 years of age) in 2019 (British Heart Foundation, 2020). Further, CVD accounts for one third of deaths Worldwide. Coronary artery disease (CAD) accounts for the greatest proportion of CVD related deaths, and risk factors including hypertension, cigarette smoking, diabetes mellitus or glucose intolerance, hypercholesterolaemia, and obesity are the top six causes of death globally (Wong, 2014). CVD constitutes a huge medical burden to the National Health Service (NHS) as they are often progressive and impose a life-long burden of intervention and treatment that require the investment of time, labour, drug therapy and other broader cost implications. The most prominent and greatest amount of treatment in CVD is linked to acquired atheromatic diseases leading to ischaemic conditions and infarctions of the myocardium, or the brain. Electrical conductance disorders (e.g. arrhythmias) and myocardial dysfunction (e.g. ventricular heart failure) often transpire from these.

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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

Cited by 5 publications

References 37 publications

Adverse functional remodelling of the subpulmonary left ventricle in patients with a systemic right ventricle is associated with clinical outcome

Adverse functional remodelling of the subpulmonary left ventricle in patients with a systemic right ventricle is associated with clinical outcome

Overview of Long-Term Outcome in Adults with Systemic Right Ventricle and Transposition of the Great Arteries: A Review

Exercise testing in cardiovascular disease

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