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Prognostic value of cardiopulmonary exercise test in children with congenital heart defects
Covadonga Terol1, Juliette Hagen1, Lukas Rammeloo2
1Department of Paediatrics, Division of Paediatric Cardiology, LUMC, Leiden, The Netherlands.
Insights
Reduced exercise capacity in children with congenital heart defects (CHDs) indicates a higher risk of future cardiovascular events. Submaximal exercise testing can predict these events when maximal testing is not feasible.
Area of Science:
- Pediatric Cardiology
- Cardiopulmonary Exercise Testing
- Congenital Heart Defects
Background:
- Cardiopulmonary exercise testing (CPET) is crucial for risk stratification in adults with congenital heart defects (CHDs).
- Its prognostic value in pediatric patients with CHDs requires further investigation.
Purpose of the Study:
- To evaluate the prognostic value of CPET in pediatric patients diagnosed with various CHDs.
- To assess the relationship between exercise capacity and future cardiovascular events in this population.
Main Methods:
- A retrospective analysis of 411 CPETs performed on pediatric patients with CHDs.
- Patients were classified based on CHD complexity using the 2018 AHA/ACC guidelines.
- Medical records were reviewed to identify cardiac events post-CPET.
Main Results:
- Patients exhibited lower than reference CPET parameters, with reduced exercise capacity in higher complexity CHDs.
- Seventy-one patients experienced cardiac events, with a median time of 28 months post-CPET.
- Lower submaximal exercise performance (e.g., %predicted oxygen uptake efficiency slope) was associated with increased cardiac events.
Conclusions:
- Diminished exercise capacity in pediatric CHD patients predicts a greater likelihood of future cardiovascular events.
- Submaximal exercise variables serve as viable predictors when maximal exercise achievement is limited.
Background:
Cardiopulmonary exercise testing (CPET) has an important prognostic value in adults with different congenital heart defects (CHDs) and is a useful tool for risk stratification and clinical decision-making. In this retrospective study, we studied the prognostic value of CPET in paediatric patients with CHD.
Methods:
411 CPET performed by paediatric patients with different CHDs were evaluated in this retrospective study. Medical records were reviewed to determine the presence of cardiac events. Participants were classified using the 2018 AHA/ACC guideline for the management of adults with CHD that combines anatomical complexity and current physiological stage.
Results:
411 patients with a median age at test of 12 years, 51 patients with simple CHD, 170 patients with moderate complexity CHD and 190 with high complexity CHD underwent CPET. Overall, CPET parameters were lower than the reference values (%predicted VO2peak=75% and %predicted oxygen uptake efficiency slope (OUES)=79%), showing worst exercise capacity in the most complex types of CHD (Group III: %predicted VO2peak=72% and %predicted OUES=75%). Seventy-one patients presented with cardiac events at a median time from CPET to first event of 28 months. Patients with cardiac events had lower exercise performance as compared with patients without cardiac events as determined by the submaximal variables (%predicted OUES: HR=2.6 (1.5-4.4), p<0.001 and VE/VCO2: HR=2.2 (1.4-3.5), p=0.001).
Conclusion:
Reduced exercise capacity at young age is related to a higher probability of future cardiovascular events in paediatric patients with CHD. Submaximal exercise variables can be used instead when maximal exercise cannot be achieved.
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