Abstract
In patients after Fontan completion exercise capacity is significantly reduced. Although peak oxygen consumption (VO2peak) is a strong prognostic factor in many cardiovascular diseases, it requires the achievement of a maximal effort. Therefore, submaximal exercise parameters such as oxygen uptake efficiency slope (OUES) may be of value. In the present observational study we evaluated the exercise capacity with maximal and submaximal parameters in a group of Fontan patients with an extracardiac conduit and determined their prognostic value. Sixty Fontan patients followed up in the Leiden University Medical Center who have performed an exercise test were included in this retrospective study. Exercise tests were performed at a median age of 11 years. Fontan patients showed on average lower values for all exercise parameters compared to reference values from a healthy dataset as shown by the %predicted values: VO2peak%:mean 66%(95%CI:64 to 74) and OUES%:mean 72%(95%CI:67 to 77). Twenty percent of the patients were not able to achieve an RER>1.0. RER showed a moderate positive correlation with VO2peak but not with OUES. There was a deterioration of VO2peak% and OUES% over time. OUES was significantly lower in patients with cardiac events in the follow up period. Fontan patients have an impaired exercise performance even at young ages and it deteriorates with age. An important percentage of Fontan patients is not able to reach maximal effort so the use of submaximal parameters, like OUES, should be considered as part of the evaluation. Moreover, OUES could have a prognostic value in this group of patients.
Highlights
We hypothesize that oxygen uptake efficiency slope (OUES), as a submaximal exercise parameter, could be useful to determine exercise capacity in young Fontan patients and could be of prognostic value for future cardiac events
This study showed that exercise capacity is impaired in paediatric Fontan patients with an ECC as determined by both maximal and submaximal parameters, and it deteriorates with age
OUES was significantly lower in patients that had a cardiac event during the follow-up period
Summary
Covadonga Terol Espinosa de los Monteros, MDa,#, Lisette M. Exercise capacity is mostly determined by the maximal cardiopulmonary exercise test (CPET) parameter peak oxygen consumption (VO2peak) and it is decreased and deteriorates over time in even asymptomatic Fontan patients.. #All the authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. It requires a maximal effort for its correct interpretation, which is often difficult in patients after TCPC. We hypothesize that OUES, as a submaximal exercise parameter, could be useful to determine exercise capacity in young Fontan patients and could be of prognostic value for future cardiac events Submaximal exercise parameters such as the OUES have been developed but it has only been used in a small number of studies with young Fontan patients. We hypothesize that OUES, as a submaximal exercise parameter, could be useful to determine exercise capacity in young Fontan patients and could be of prognostic value for future cardiac events
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