Related Experiment Video
Updated: Feb 10, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testing
Sílvia Aguiar Rosa1, Ana Agapito1, Rui M Soares1
1Cardiology Department, Santa Marta Hospital, Lisbon, Portugal.
Insights
Congenital heart disease (CHD) patients with cardiac shunts, especially Eisenmenger syndrome, and complex defects exhibit reduced functional capacity. These conditions also show an impaired ability to increase heart rate during exercise.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Exercise Physiology
Background:
- Congenital heart disease (CHD) encompasses a range of structural abnormalities present at birth.
- Functional capacity assessment is crucial for managing CHD patients and predicting outcomes.
- Cardiopulmonary exercise testing (CPET) provides objective measures of cardiopulmonary function.
Purpose of the Study:
- To compare functional capacity across various types of congenital heart disease (CHD).
- To assess differences using cardiopulmonary exercise testing (CPET) in adult CHD patients.
- To identify specific CHD subtypes associated with diminished exercise capacity.
Main Methods:
- Retrospective analysis of 154 adult patients with CHD who underwent CPET.
- Categorization of CHD diagnoses including repaired tetralogy of Fallot, TGA, complex defects, shunts, and others.
- Comparison of CPET parameters such as peak oxygen consumption (VO2) and ventilation/carbon dioxide production slope between groups.
Main Results:
- Significant differences in functional capacity were observed among CHD groups.
- Patients with cardiac shunts, particularly Eisenmenger syndrome, demonstrated the lowest peak VO2 and highest ventilation/carbon dioxide production slope.
- Complex defects were associated with the lowest percentage of predicted peak VO2 and impaired chronotropic response.
Conclusions:
- Cardiac shunts (especially Eisenmenger syndrome) and complex defects are linked to reduced functional capacity in CHD patients.
- An attenuated chronotropic response to exercise is characteristic of these CHD subtypes.
- CPET parameters can help stratify risk and guide management in adult CHD.
Aim:
The aim of the study was to compare functional capacity in different types of congenital heart disease (CHD), as assessed by cardiopulmonary exercise testing (CPET).
Methods:
A retrospective analysis was performed of adult patients with CHD who had undergone CPET in a single tertiary center. Diagnoses were divided into repaired tetralogy of Fallot, transposition of the great arteries (TGA) after Senning or Mustard procedures or congenitally corrected TGA, complex defects, shunts, left heart valve disease and right ventricular outflow tract obstruction.
Results:
We analyzed 154 CPET cases. There were significant differences between groups, with the lowest peak oxygen consumption (VO2) values seen in patients with cardiac shunts (39% with Eisenmenger physiology) (17.2±7.1ml/kg/min, compared to 26.2±7.0ml/kg/min in tetralogy of Fallot patients; p<0.001), the lowest percentage of predicted peak VO2 in complex heart defects (50.1±13.0%) and the highest minute ventilation/carbon dioxide production slope in cardiac shunts (38.4±13.4). Chronotropism was impaired in patients with complex defects. Eisenmenger syndrome (n=17) was associated with the lowest peak VO2 (16.9±4.8 vs. 23.6±7.8ml/kg/min; p=0.001) and the highest minute ventilation/carbon dioxide production slope (44.8±14.7 vs. 31.0± 8.5; p=0.002). Age, cyanosis, CPET duration, peak systolic blood pressure, time to anaerobic threshold and heart rate at anaerobic threshold were predictors of the combined outcome of all-cause mortality and hospitalization for cardiac cause.
Conclusion:
Across the spectrum of CHD, cardiac shunts (particularly in those with Eisenmenger syndrome) and complex defects were associated with lower functional capacity and attenuated chronotropic response to exercise.
Related Concept Videos
01:21Cardiopulmonary Resuscitation I: Adult
01:47Lung Capacity
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:25Pulmonary Function Tests
Pulmonary Function Tests are crucial diagnostic tools for assessing respiratory function, particularly in patients with chronic respiratory disorders. They comprehensively evaluate lung volumes, ventilatory function, breathing mechanics, diffusion, and gas exchange. These tests help diagnose pulmonary diseases and play a significant role in monitoring disease progression, evaluating disability, and assessing response to therapy.
PFTs involve using a spirometer, a...
01:23Rheumatic Heart Disease I: Introduction
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...