Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-16T07:26:28.349Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of peak respiratory exchange ratio on the prognostic power of symptoms-limited exercise testing using Bruce protocol in patients with Fontan physiology

Published online by Cambridge University Press:  19 November 2020

Jianli Niu ,
Aliana Godoy ,
Talya Kadish  and
Bibhuti B. Das Open the ORCID record for Bibhuti B. Das [Opens in a new window]
Jianli Niu
Affiliation:
Clinical Research, Office of Human Research, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FL, USA
Aliana Godoy
Affiliation:
Clinical Research, Office of Human Research, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FL, USA
Talya Kadish
Affiliation:
Clinical Research, Office of Human Research, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FL, USA
Bibhuti B. Das*
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital Specialty Care, Austin, TX, USA
*
Author for correspondence: B. B. Das, MD, FAAP, FACC, Department of Paediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Austin Specialty Care, Austin, TX78759, USA. Tel: +1 737 220 8328; Fax: +1 737 220 8180. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

We evaluated the impact of peak respiratory exchange ratio on the prognostic values of cardiopulmonary exercise variables during symptoms-limited incremental exercise tests in patients with Fontan physiology.

Methods:

Retrospective single-centre chart review study of Fontan patients who underwent exercise testing using the Bruce protocol between 2014 and 2018 and follow-up.

Results:

A total of 34 patients (age > 18 years) had a Borg score of ≥7 on the Borg 10-point scale, but only 50% of patients achieved a peak respiratory exchange ratio of ≥ 1.10 (maximal test). Peak oxygen consumption, percent-predicted peak oxygen consumption, and peak oxygen consumption at the ventilatory threshold was reduced significantly in patients with a peak respiratory exchange ratio of < 1.10. Peak oxygen consumption and percent-predicted peak oxygen consumption was positively correlated with peak respiratory exchange ratio values (r = 0.356, p = 0.039). After a median follow-up of 21 months, cardiac-related events occurred in 16 (47%) patients, with no proportional differences in patients due to their respiratory exchange ratio (odds ratio, 0.62; 95% CI: 0.18–2.58; p = 0.492). Multivariate Cox proportional hazard analysis showed percent-predicted peak oxygen consumption, peak heart rate, and the oxygen uptake efficient slope were highly related to the occurrence of events in patients only with a peak respiratory exchange ratio of ≥ 1.10.

Conclusions:

The value of peak cardiopulmonary exercise variables is limited for the determination of prognosis and assessment of interventions in Fontan patients with sub-maximal effort. Our findings deserve further research and clinical application.

Keywords

Cardiopulmonary exercise testpeak respiratory exchange ratioFontanoutcomes analysis
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 2 , February 2021 , pp. 216 - 223
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Burstein, DS, Menachem, JN, Opotowsky, AR. Exercise testing for assessment of heart failure in adults with congenital heart disease. Heart Fail Rev 2019. doi: 10.1007/s10741-019-09867-1 Google Scholar
Wensel, R, Opitz, CF, Anker, SD, et al. Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation 2000; 106: 319–324.CrossRefGoogle Scholar
Ogawa, T, Spina, RJ, Martin, WH, et al. Effects of aging, sex, and physical training on cardiovascular responses to exercise. Circulation 1992; 86: 494–503.CrossRefGoogle ScholarPubMed
Woo, JS, Derleth, C, Stratton, JR, Levy, WC. The influence of age, gender, and training on exercise efficiency. J Am Coll Cardiol 2006; 47: 1049–1057.CrossRefGoogle ScholarPubMed
Inuzuka, R, Diller, GP, Borgia, F, et al. Comprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term. Circulation 2012; 125: 250–259.CrossRefGoogle ScholarPubMed
Ramos-Barbon, D, Fitchett, D, Gibbons, WJ, Latter, DA, Levy, RD. Maximal exercise testing for the selection of heart transplantation candidates: limitation of peak oxygen consumption. Chest 1999; 115: 410–417.CrossRefGoogle ScholarPubMed
Driscoll, DJ. Cardiorespiratory responses to exercise after the Fontan operation. Circulation 1990; 81: 2016–2017.Google ScholarPubMed
Fernandes, SM, Alexander, ME, Graham, DA, et al. Exercise testing identifies patients at increased risk for morbidity and mortality following Fontan surgery. Congenit Heart Dis 2011; 6: 294–303.CrossRefGoogle ScholarPubMed
Ohuchi, H, Negishi, J, Noritake, K, et al. Prognostic value of exercise variables in 335 patients after the Fontan operation: a 23-year single-center experience of cardiopulmonary exercise testing. Congenit Heart Dis 2015; 10: 105–116.CrossRefGoogle ScholarPubMed
Udholm, S, Aldweib, N, Hjortdal, VE, et al. Prognostic power of cardiopulmonary exercise testing in Fontan patients: a systemic review. Open Heart 2018; 5: e000812.CrossRefGoogle Scholar
Baba, R, Nagashima, M, Goto, M, et al. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol 1996; 28: 1567–1572.Google ScholarPubMed
Mezzani, A, Corra, U, Bosimini, E, et al. Contribution of peak respiratory exchange ratio to peak VO2 prognostic reliability in patients with chronic heart failure and severely reduced exercise capacity. Am Heart J 2003; 145:1102–1107.CrossRefGoogle ScholarPubMed
Gibbons, RJ, Balady, GJ, Bricker, JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002; 40: 1531–1540.CrossRefGoogle Scholar
Chase, PJ, Kenjale, A, Cahalin, LP, et al. Effects of respiratory exchange ratio on the prognostic value of peak oxygen consumption and ventilator efficiency in patients with systolic heart failure. JACC Heart Failure 2013; 1: 427–432.Google Scholar
Kakutani, N, Fukushima, A, Yokota, T, et al. Impact of high respiratory exchange ratio during submaximal exercise on adverse clinical outcome in heart failure. Circ J 2018; 82: 2753–2760.Google ScholarPubMed
Fletcher, GF, Balady, GJ, Amsterdam, EA, et al. Exercise standards for testing and training: a statement for healthcare professionals from American Heart Association. Circulation 2001; 104: 1694–1740.CrossRefGoogle ScholarPubMed
Hollenberg, M, Tager, IB. Oxygen uptake efficiency slope: an index of exercise performance and cardiopulmonary reserve requiring only submaximal exercise. J Am Coll Cardiol 2000; 36: 194–201.CrossRefGoogle ScholarPubMed
Kempny, A, Dimopoulos, K, Eebing, A, et al. Reference values for exercise limitations among adults with congenital heart disease: relation to activities of daily life-single center experience and review of published data. Eur Heart J 2012; 33: 1386–1396.CrossRefGoogle Scholar
Rostagno, C, Olivo, G, Comeglio, M, et al. Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation. Eur J Heart Fail 2003; 5: 247–52.CrossRefGoogle ScholarPubMed
Bongers, BC, Hulzebos, EH, Helbing, WA, et al. Response profiles of oxygen uptake efficiency during exercise in healthy children. Eur J Prev Cardiol 2016 23: 865–873.CrossRefGoogle ScholarPubMed
Diller, GP, Giardini, A, Dimopoulos, K, et al. Predictors of morbidity and mortality in contemporary Fontan patients: results from a multicenter study including cardiopulmonary exercise testing in 321 patients. Eur Heart J 2010; 31: 3073–3083.CrossRefGoogle ScholarPubMed
Ackermann, M, van Brussel, M, Hulzebos, E, et al. The oxygen uptake efficiency slope; what do we know? J Cardiopulm Rehab Prev 2010; 30:357–373.CrossRefGoogle Scholar
Malhotra, R, Bakken, K, D’Elia, E, Lewis, GD. Cardiopulmonary exercise testing in heart failure. JACC Heart Failure 2016; 4:607–16.CrossRefGoogle ScholarPubMed
Dimopoulos, K, Okonko, DO, Diller, GP, et al. Abnormal ventilator response to exercise in adults with congenital heart disease relates to cyanosis and predicts survival. Circulation 2006; 113: 2796–2802 CrossRefGoogle Scholar
Atz, AM, Zak, V, Mahony, L, et al. Longitudinal outcomes of patients with single ventricle after the Fontan procedure. J Am Coll Cardiol 2017; 69:2735–2744.CrossRefGoogle ScholarPubMed
Giardini, A, Specchia, S, Gargiulo, G, et al. Accuracy of oxygen uptake efficiency slope in adults with congenital heart disease. Int J Cardiol 2009;133:74–79 Google ScholarPubMed
Classen, G, La Gerche, A, Van De Bruaene, A, et al. Heart rate reserve in Fontan patients: chronotropic incompetence or hemodynamic limitation? J Am Heart Assoc 2019; 8:e012008 Google Scholar
Egbe, AC, Driscoll, DJ, Khan, AR et al. Cardiopulmonary exercise test in adults with prior Fontan operation: the prognostic value of serial testing. Int J Cardiol 2017; 235: 6–10.CrossRefGoogle ScholarPubMed
Mancini, DM, Eisen, H, Kussmaul, W, Mull, R, Edmunds, LH Jr, Wilson, JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991; 83: 778–786.CrossRefGoogle ScholarPubMed
Clark, AL, Poole-Wilson, PA, Coats, AJ. Exercise limitation in chronic heart failure: central role of the periphery. J Am Coll Cardiol 1996; 28: 1092–1102.CrossRefGoogle ScholarPubMed
Blumenthal, JA, Babyak, MA, O’Connor, C, et al. Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA 2012; 308: 465–474.CrossRefGoogle ScholarPubMed