NYHA class and cardiopulmonary exercise capacity impact self-rated health-related quality of life in young adults after arterial switch operation for transposition of the great arteries

Abstract

BackgroundEvaluating the impact of subjective physical activity status and cardiopulmonary exercise capacity on physical and mental health-related quality of life (QOL) in young adults after neonatal arterial switch operation for transposition of the great arteries. MethodsIn a prospective reassessment study, 92 young adults (age 22.8 ​± ​2.6 ​y) underwent standardized evaluation of health-related QOL (SF-36), NYHA status and cardiopulmonary exercise performance (CPET). ResultsPeak oxygen uptake was 33.1 ​± ​7.1 ​ml/kg/min corresponding to 84.5 ​± ​15.5% of predicted, according to the borderline subnormal range. 65% were classified as normal or borderline, 35% as impaired. 88% were NYHA class I and 12% class II, 45% exercised regularly. Despite average or even elevated mean scores for the QOL domains, more patients reported significantly poorer results, indicated by increased percentages below −2 SD for physical (5.6%), social (7.8%) and emotional role functioning (8.8%). Significant correlations existed between physical health domains and objective exercise performance (r ​= ​0.23 to 0.34, p ​= ​0.001 to 0.032) as well as NYHA class (r ​= ​0.33 to 0.46, p ​< ​0.001 to 0.002). Mental health domains were also significantly correlated with NYHA class (r ​= ​0.22 to 0.41, p ​≤ ​0.001 to 0.04) and peak oxygen uptake. ConclusionsDespite good results on average, young adults with TGA after ASO are at elevated risk for a reduced QOL. Objective exercise capacity and NYHA class are significant indicators for self-perceived physical and mental health. Applications of QOL measurement should be part of routine clinical follow up in this patient group.