Percentage Predicted Peak Oxygen Consumption in People With Fontan Circulation: A Rapid Systematic Scoping Review and...

Area of Science:

• Cardiology
• Exercise Physiology
• Congenital Heart Disease Research

Background:

• Peak oxygen consumption (peak VO2) is a key metric for individuals with congenital heart disease (CHD).
• It is typically reported as a percentage of predicted values derived from age- and sex-matched normative reference values (NRVs).
• The appropriateness and validity of NRVs in the CHD population require critical evaluation.

Purpose of the Study:

• To identify the specific NRVs utilized in studies involving peak VO2 in CHD.
• To assess the accuracy and appropriateness of NRV application in this population.
• To evaluate the validity of commonly recommended NRVs when applied to individuals with CHD.

Main Methods:

• A systematic scoping review identified relevant studies reporting peak VO2 percentage of predicted value in CHD.
• A modified risk of bias tool was employed to assess the quality of included studies.
• The validity of American Heart Association-recommended NRVs was examined using a Fontan circulation cohort.

Main Results:

• Forty-five studies reported peak VO2 percentage, but only 47% detailed their calculation method.
• Wasserman (n=12) and Cooper and Weiler-Ravell (n=7) were the most cited NRVs.
• The Wasserman NRV demonstrated poor validity, showing no significant association with measured peak VO2 in a Fontan cohort (men: R²≤0.01; women: R²=0.02).

Conclusions:

• A wide array of NRVs are applied to CHD patients, often with inadequate reporting and mismatched application.
• The frequently cited Wasserman NRV lacks validity when applied to individuals with a Fontan circulation.
• There is a critical need for validated and consistently applied NRVs for peak VO2 assessment in CHD.