Key result
Abnormal O2 pulse trajectory in ACHD is linked to ~3 mL/kg/min lower VO2peak.
Why the study?
Peak oxygen uptake and peak oxygen pulse are standard in managing adults with congenital heart disease (ACHD), but the utility of the O2 pulse trajectory in relation to clinical status and cardiac function is understudied.
Does an abnormal oxygen pulse trajectory differentiate disease severity, clinical status, and cardiac function compared to a normal oxygen pulse trajectory in adults with congenital heart disease?
Cohort (n=223)
Does an abnormal oxygen pulse trajectory differentiate disease severity, clinical status, and cardiac function compared to a normal oxygen pulse trajectory in adults with congenital heart disease?
Evaluating the exercise oxygen pulse trajectory during cardiopulmonary exercise testing provides non-invasive insight into anatomic complexity, functional status, and biventricular cardiac index in adults with congenital heart disease.
Answers are grounded in this paper and cite their sources.
May support exercise interventions to enhance peak oxygen uptake in congenital heart disease; hypothesis-generating pending randomized confirmation.
Background Peak oxygen uptake (VO 2peak ) and peak oxygen pulse (O 2 pulse) are standard in the clinical management of adults with congenital heart disease (ACHD), however the utility of the O 2 pulse trajectory (pattern of exercise O 2 pulse kinetics) is understudied. Objectives To assess the relationship between O 2 pulse trajectory, clinical status, and cardiac function in patients with ACHD. Methods Analysis of patients with ACHD who underwent clinically-referred cardiopulmonary exercise testing and cardiovascular magnetic resonance. The O 2 pulse trajectory was defined as normal (normal curvilinear pattern) or abnormal (flat or decreasing pattern) based upon graphical plots of exercise O 2 pulse. Anatomic complexity was defined as simple, moderate, or great. Physiologic stage was determined by VO 2peak to estimate New York Heart Association (NYHA) functional status. Cardiac function was based on resting cardiac index (CI) derived from phase-contrast velocity mapping aortic and pulmonary forward flows and resting heart rate. Results A total of 223 patients were evaluated (median age: 33 [26-42] years; 55% female; 60.5% moderate anatomic complexity). An abnormal O 2 pulse trajectory (49% of patients) was associated with greater anatomic complexity ( P =0.014), higher NYHA classification ( P =0.009), lower VO 2peak (19.8 [16.0-24.7] vs. 23.0 [17.1-29.4] mL·kg -1 ·min -1 ; P =0.007), and higher chronotropic index (1.28 [1.11-1.45] vs. 0.90 [0.75-1.10]; P <0.001). Both right (CI: 2.57 [2.15-2.97] vs. 3.05 [2.42-3.53] L/min/m 2 ; P =0.003) and left (CI: 2.51 [2.17-3.25] vs. 2.82 [2.44-3.41] L/min/m 2 ; P =0.033) cardiac function were lower with an abnormal trajectory. Conclusions An abnormal O 2 pulse trajectory is associated with greater anatomic complexity, lower functional status, and worsened cardiac function in a large cohort of ACHD.
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Canada et al. (2026) conducted a cohort in Adults with congenital heart disease (ACHD) (n=223). Abnormal oxygen pulse trajectory (flat or decreasing pattern) vs. Normal oxygen pulse trajectory (normal curvilinear pattern) was evaluated on Peak oxygen uptake (VO2peak, mL/kg/min) (p=0.007). Abnormal O2 pulse trajectory in ACHD was associated with lower VO2peak (19.8 vs 23.0 mL/kg/min; P=0.007) and lower right (2.57 vs 3.05; P=0.003) and left (2.51 vs 2.82; P=0.033) cardiac index.
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