Key result
Fontan patients under 15 years of age had impaired exercise capacity (mean predicted VO2peak 66%, OUES 72%), and OUES was significantly lower in patients with cardiac events during follow-up.
Why the study?
Peak oxygen consumption requires maximal effort in Fontan patients with reduced exercise capacity, making submaximal exercise parameters like the oxygen uptake efficiency slope potentially valuable for evaluation and prognosis.
Do submaximal exercise parameters like OUES have prognostic value for cardiac events in young Fontan patients?
Observational (n=60)
No
Do submaximal exercise parameters like OUES have prognostic value for cardiac events in young Fontan patients?
Submaximal exercise parameters like OUES are impaired in young Fontan patients and may offer prognostic value for future cardiac events, especially since many cannot achieve maximal effort.
OUES may refine prognosis in young Fontan patients unable to reach maximal effort; leaves open routine clinical use pending prospective validation.
In patients after Fontan completion exercise capacity is significantly reduced. Although peak oxygen consumption (VO 2peak ) 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: VO 2peak %: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 VO 2peak but not with OUES. There was a deterioration of VO 2peak % 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.
No takes yet. Share an insight, caveat, or question.
Monteros et al. (2021) conducted an observational in Fontan patients with an extracardiac conduit (n=60). Maximal and submaximal exercise performance (VO2peak and OUES) vs. Healthy reference dataset was evaluated on Exercise capacity (VO2peak% and OUES%). Fontan patients under 15 years of age had impaired exercise capacity (mean predicted VO2peak 66%, OUES 72%), and OUES was significantly lower in patients with cardiac events during follow-up.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: