title: Oxygen uptake versus exercise intensity: a new concept in assessing cardiovascular exercise function in patients with congenital heart disease.
abstract: OBJECTIVE
  To assess the relation between exercise intensity and oxygen uptake during graded exercise in paediatric patients who underwent surgical repair of congenital heart disease, and to compare it with conventional measures of aerobic exercise function.
  
  
  METHODS
  Cross sectional study. Exercise testing was performed on a treadmill and gas exchange was measured on a breath by breath basis.
  
  
  METHODS
  29 patients who underwent an atrial switch operation for transposition of the great arteries (TGA) (mean (SD) age at testing 10.3 (2.5) years) and 30 patients who underwent total repair of tetralogy of Fallot (TF) (age 12.1 (3.3) years) performed graded exercise testing. Exercise responses were compared with data obtained in 24 normal controls (age 11.4 (2.6) years).
  
  
  RESULTS
  The slope of oxygen uptake versus exercise intensity averaged 1.50 (0. 64) ml O(2)/min(2)/kg in the patients with TGA and 1.68 (0.75) ml O(2)/min(2)/kg after TF repair, both lower (p < 0.005) than in normal controls (2.42 (0.68) ml O(2)/min(2)/kg). The lower slope of oxygen uptake was correlated with a subnormal value for ventilatory anaerobic threshold, which averaged 78.0 (13.3)% of normal in TGA and 85.1 (10.6)% in TF. This was associated with a steeper slope (p = 0.001) of carbon dioxide output versus oxygen uptake above the ventilatory anaerobic threshold in TGA (1.26 (0.20)) and TF (1.20 (0. 18)) compared with the normal controls (1.05 (0.13)), and also a steeper slope of ventilation versus carbon dioxide in TGA (47.0 (15. 4)) and TF (41.5 (13.7)) than in the controls (30.3 (8.5)).
  
  
  CONCLUSIONS
  Calculation of the steepness of the slope of oxygen uptake versus exercise intensity is a valid measurement of oxygen flow to the exercising tissues, which may be limited in congenital heart disease.
authors.affiliation: Cardiovascular Rehabilitation Unit, Department of Rehabilitation Sciences, University of Leuven, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. tony.reybrouck@uz.kuleven.ac.be
authors.forename: T
authors.initials: T
authors.lastname: Reybrouck
authors.forename: L
authors.initials: L
authors.lastname: Mertens
authors.forename: S
authors.initials: S
authors.lastname: Brusselle
authors.forename: M
authors.initials: M
authors.lastname: Weymans
authors.forename: B
authors.initials: B
authors.lastname: Eyskens
authors.forename: J
authors.initials: J
authors.lastname: Defoor
authors.forename: M
authors.initials: M
authors.lastname: Gewillig
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D010101:Oxygen Consumption; D011184:Postoperative Period; D011659:Pulmonary Gas Exchange; D013771:Tetralogy of Fallot / Q000601:surgery; D014188:Transposition of Great Vessels / Q000378:metabolism* / Q000601:surgery*