Exercise capacity, cardiac and endothelial function in adults with repaired tetralogy of Fallot

Exercise capacity and endothelial function are impaired in adults with repaired tetralogy of Fallot (ToF). This may be related to pathophysiological determinants, such as cardiac and endothelial impairment, or to a more sedentary lifestyle. Therefore, we sought to assess if cardiac and endothelial function are associated with exercise capacity in adults with repaired ToF.

In a case-control study, we compared adults with repaired ToF and controls in terms of exercise workload, peak oxygen consumption (VO2peak) and flow-mediated dilation (FMD). Additionally, we determined associations of natriuretic peptide levels, echocardiographic parameters of size, function and systolic pressure with exercise capacity.

A total of 26 patients (mean age 38 ​± ​10 years, 46% males) and 10 controls were included. Patients with repaired ToF had reduced VO2peak (25.0 vs. 36.3 ​ml/kg/min, p ​< ​0.001) and FMD (7.6 vs. 10.8%, p ​= ​0.007) compared to controls. Exercise workload was moderately associated with FMD (r ​= ​0.428, p ​= ​0.029) and right ventricular parameters, while VO2peak was moderately associated with natriuretic peptide levels (r ​= ​-0.523, p ​= ​0.006).

Adults with repaired ToF have impaired exercise capacity and endothelial function as compared to healthy controls. Natriuretic peptide levels and FMD are moderately associated with exercise capacity in adults with repaired ToF.