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Implantation of Total Artificial Heart in Congenital Heart Disease
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Which classification best predicts functional status in children with CHD?

Arthur Gavotto1,2, Ines Liard3, Helena Huguet4

  • 1Department of Neonatal Medicine and Paediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France.

Cardiology in the Young
|May 19, 2025
PubMed
Summary

The Uzark classification is the most reliable for predicting functional status and reproducibility in children with congenital heart disease (CHD). This simple tool aids in identifying at-risk children for early cardiovascular intervention.

Keywords:
CHDExercise testphysical fitnessquality of liferisk factors

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Area of Science:

  • Paediatric Cardiology
  • Cardiovascular Research
  • Congenital Heart Disease (CHD) Management

Background:

  • Advances in CHD care shift focus from mortality to lifelong morbidity.
  • Need for a simple, reproducible CHD classification to stratify disease severity.
  • Current research prioritizes functional and patient-reported outcomes.

Purpose of the Study:

  • To identify the optimal CHD classification for predicting functional status in children.
  • To assess which classification best correlates with cardiopulmonary fitness.

Main Methods:

  • Retrospective cohort study of 296 children with CHD.
  • Involved baseline and final cardiopulmonary exercise tests over a mean follow-up of 4.1 years.
  • Evaluated seven different CHD classifications.

Main Results:

  • The Uzark et al. four-stage paediatric CHD classification best predicted functional status.
  • Achieved an AUC of 0.62 for impaired cardiopulmonary fitness (VO2max or VAT < -1.64 Z-score).
  • Demonstrated the highest inter-judge agreement (Kappa = 0.88).

Conclusions:

  • The Uzark classification is a reliable tool for predicting functional status in pediatric CHD.
  • It offers excellent reproducibility, crucial for clinical application.
  • Facilitates early identification of children at risk for cardiopulmonary impairment, enabling timely interventions.