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Determinants of oxygen uptake and prognostic factors in cardiopulmonary exercise test in patients with Fontan surgery

Published online by Cambridge University Press:  04 October 2021

Maria Martin Talavera Open the ORCID record for Maria Martin Talavera [Opens in a new window] ,
Begoña Manso ,
Pilar Cejudo Ramos ,
Maria Jose Rodriguez Puras ,
Amadeo J Wals Rodriguez  and
Pastora Gallego Garcia de Vinuesa
Maria Martin Talavera
Affiliation:
Paediatric Cardiology Section, GUCH transition clinic, Children Hospital Virgen del Rocio, Virgen del Rocio University Hospital, Seville, Spain
Begoña Manso*
Affiliation:
Paediatric Cardiology Section, GUCH transition clinic, Children Hospital Virgen del Rocio, Virgen del Rocio University Hospital, Seville, Spain
Pilar Cejudo Ramos
Affiliation:
Pulmonary Rehabilitation Unit, Virgen del Rocio University Hospital, Seville, Spain
Maria Jose Rodriguez Puras
Affiliation:
Adult Congenital Heart Disease Unit, Virgen del Rocio University Hospital, Seville, Spain
Amadeo J Wals Rodriguez
Affiliation:
Adult Congenital Heart Disease Unit, Virgen del Rocio University Hospital, Seville, Spain
Pastora Gallego Garcia de Vinuesa
Affiliation:
Adult Congenital Heart Disease Unit, Virgen del Rocio University Hospital, Seville, Spain
*
Author for correspondence: B. Manso, Paediatric Cardiology Section, Transitional Unit, Children Hospital Virgen del Rocio, Virgen del Rocio University Hospital, Seville, Spain. Tel: +34 669896556. E-mail: bemangar@hotmail.com
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Abstract

Introduction:

Cardiopulmonary exercise test (CPET) allows quantification of functional capacity of patients with Fontan. The objective of this study was to determine the role of CPET parameters in predicting a higher maximum oxygen consumption (VO2 max) and to analyse the role of CPET parameters in predicting an unfavourable outcome.

Methods:

A retrospective, cross-sectional, descriptive study was carried out on 57 patients with Fontan, who had undergone incremental CPET with cycloergometer between 2010 and 2020. Determinants of VO2 max and determinants of clinical deterioration were analysed.

Results:

In the univariate analysis, the variables significantly related to VO2 max were: age, sex, body mass index (BMI), years of Fontan evolution, intracardiac Fontan, oxygen consumption at anaerobic threshold (VO2AT), CO2 equivalents at anaerobic threshold (VE/VCO2) and chronotropic insufficiency. The multiple linear regression model that best fitted the relationship between VO2 max and independent variables (correlation coefficient 0.73) included sex (correlation index 3.35; p = 0.02), BMI (−0.27; p = 0.02), chronotropic failure (−2.79; p = 0.01) and VO2AT (0.92; p < 0.0001). In the univariate analysis of the prognostic CPET variables related to an unfavourable clinical situation, significance was only obtained with chronotropic insufficiency (p = 0.003). In multivariate analysis, chronotropic insufficiency maintains its association [p= 0.017, OR = 4.65 (1.3–16.5)].

Conclusions:

In conclusion, together with the anthropometric parameters universally related to VO2 max, chronotropic insufficiency and VO2AT are the main determinants of functional capacity in patients with Fontan. Moreover, chronotropic insufficiency is closely related to unfavourable clinical evolution. Our data would support the intensive treatment of chronotropic insufficiency in order to improve the quality of life and the clinical situation of patients with Fontan.

Keywords

Cardiopulmonary exercise testingoxygen consumptionFontancongenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 8 , August 2022 , pp. 1285 - 1288
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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