Key result
Repaired tetralogy of Fallot was associated with significantly lower peak exercise capacity (80.4% vs 102.6%, p<0.001) and chronotropic incompetence compared to healthy controls.
Why the study?
Do children and young adults with repaired tetralogy of Fallot have impaired functional status compared to healthy controls?
Cohort (n=1,806)
No
Do children and young adults with repaired tetralogy of Fallot have impaired functional status compared to healthy controls?
Absolute Event Rate: 80.4% vs 102.6%
p-value: p=<0.001
Contemporary children and young adults with repaired tetralogy of Fallot continue to exhibit significant functional limitations in exercise capacity and physical fitness compared to healthy peers.
Impaired exercise capacity in repaired tetralogy of Fallot may prompt closer monitoring; leaves open whether interventions improve long-term outcomes.
OBJECTIVE: Functional outcome measures are of growing importance in the aftercare of patients with congenital heart disease. This study addresses the functional status with regard to exercise capacity, health-related physical fitness (HRPF) and arterial stiffness in a recent cohort of children, adolescents and young adults with tetralogy of Fallot (ToF) after repair. DESIGN: Single-centre, uncontrolled and prospective cohort study. SETTING: Outpatient department of the German Heart Centre Munich; July 2014-January 2018. PATIENTS: One hundred and six patients with ToF after repair (13.5±3.7 years, 40 females) were included. Data were compared with a recent cohort of healthy controls (HCs) (n=1700, 12.8±2.6 years, 833 females). MAIN OUTCOME MEASURES: Patients underwent a symptom-limited cardiopulmonary exercise test, performed an HRPF test (FitnessGram) and had an assessment of their arterial stiffness (Mobil-O-Graph). RESULTS: peak (ToF: 80.4% ± 16.8% vs HC: 102.6% ± 18.1%, p<0.001), impaired ventilatory efficiency (ToF: 29.6 ± 3.6 vs HC: 27.4 ± 2.9, p<0.001), chronotropic incompetence (ToF: 167 ± 17 bpm vs HC: 190 ± 17 bpm, p<0.001) and reduced HRPF (ToF z-score: -0.65 ± 0.87 vs HC z-score: 0.03 ± 0.65, p<0.001). Surrogates of arterial stiffness, central and peripheral systolic blood pressure, did not differ between the two groups. CONCLUSIONS: Contemporary children, adolescents and young adults with ToF still have functional limitations. How impaired HRPF and limited exercise capacity interact and how they can be modified needs to be evaluated in further intervention studies.
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Hock et al. (2018) conducted a cohort in Tetralogy of Fallot after repair (n=1,806). Repaired tetralogy of Fallot vs. Healthy controls was evaluated on Peak exercise capacity (p=<0.001). Repaired tetralogy of Fallot was associated with significantly lower peak exercise capacity (80.4% vs 102.6%, p<0.001) and chronotropic incompetence compared to healthy controls.
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