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Prognostic value of submaximal exercise data for cardiac morbidity in fontan patients

机译：次最大运动数据对font门病患者心脏疾病的预后价值

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INTRODUCTION: Submaximal exercise parameters are associated with an increased risk of hospitalization in patients with heart failure, but the implication in patients with Fontan circulation remains unknown. We investigated the prognostic value of these parameters in a Fontan cohort, in whom maximal exercise effort is often limited. METHODS: Fifty-two Fontan patients received cardiopulmonary exercise tests at least 12 months after Fontan completion. We evaluated two maximal parameters (peak oxygen consumption (V?O2) and HR reserve) and two submaximal parameters (oxygen uptake efficiency slope (OUES) and minute ventilation (V?E) to carbon dioxide elimination (V?CO2) slope). RESULTS: The peak V?O2 and OUES were 58.0% ± 11.2% and 56.6% ± 14.5% of the age- and sex-related predicted values. In the subsequent follow-up (median, 22.7 months), 11 patients (21%, including one death) exhibited cardiac morbidity, defined as cardiac-related hospitalization. Time-dependent receiver operating characteristic curve analysis demonstrated that only submaximal parameters were related to 2-yr cardiac morbidity (area under the curve for OUES 0.781, P = 0.018; for V?E/V?CO2 slope 0.714, P = 0.04), even in the subgroup achieved maximal exercise effort. The optimal threshold value for OUES was 45%, and for the V?E/V?CO2 slope, it was 37. Furthermore, the OUES conveyed independent prognostic information beyond resting oxygen saturation and a history of heart failure or protein-losing enteropathy. CONCLUSION: Submaximal exercise parameters provide superior prognostic information to maximal exercise data for predicting cardiac morbidity in Fontan patients. Moreover, the association between the OUES and cardiac morbidity is independent of relevant baseline clinical information.
机译：引言：亚最大运动参数与心力衰竭患者住院风险增加有关，但对丰坦循环患者的影响尚不清楚。我们在丰坦队列中研究了这些参数的预后价值，在该队列中最大的运动量通常是有限的。方法：52名Fontan患者在Fontan完成后至少12个月接受了心肺运动测试。我们评估了两个最大参数（峰值耗氧量（V2O2）和HR储备）和两个次最大参数（吸氧效率斜率（OUES）和分钟通气量（V？E）至二氧化碳消除量（V？CO2）斜率）。结果：峰值V？O2和OUES分别为与年龄和性别相关的预测值的58.0％±11.2％和56.6％±14.5％。在随后的随访中（中位22.7个月），有11例患者（21％，包括1例死亡）表现出心脏疾病，定义为与心脏相关的住院。随时间变化的接收器工作特性曲线分析表明，仅次最大参数与2年心脏发病率有关（OUES为0.781，曲线下面积为P = 0.018; V？E / V？CO2斜率为0.714，P = 0.04），即使在亚组中也达到了最大的运动强度。 OUES的最佳阈值为45％，而V？E / V？CO2斜率的最佳阈值为37。此外，OUES传达的独立预后信息还包括静息氧饱和度和心力衰竭或蛋白丢失性肠病史。结论：亚最大运动参数为预测丰坦患者的心脏发病率提供了比最大运动数据更好的预后信息。此外，OUES和心脏发病率之间的关联与相关的基线临床信息无关。

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