title: Ventilatory efficiency and aerobic capacity predict event-free survival in adults with atrial repair for complete transposition of the great arteries.
abstract: OBJECTIVE
  The goal of this study was to assess the prognostic value of the cardiopulmonary exercise test (CPET) in patients who received a Mustard and Senning (M/S) operation.
  
  
  BACKGROUND
  Patients who received an M/S operation have increased long-term risk of cardiovascular morbidity and mortality. Limited information is available on how to stratify risk in this population.
  
  
  METHODS
  Between 1996 and 2007, 274 adults (age 26.3 +/- 8.9 years, range 16 to 50 years) who had received a Mustard (n = 144) or Senning (n = 130) operation in infancy were studied with CPET. During a follow-up of 3.9 +/- 2.3 years (range 0.2 to 10.8 years), 12 patients died at an age of 36 +/- 14 years, and 46 patients required a cardiac-related emergency (<24 h from the onset of symptom/condition) hospital admission at an age of 30 +/- 11 years.
  
  
  RESULTS
  At multivariate Cox analysis, the slope of ventilation per unit of carbon dioxide output (VE/VCO(2) slope) (hazard ratio: 1.088, p < 0.0001) and percentage of predicted peak oxygen uptake (Vo(2)%) (hazard ratio: 0.979, p = 0.0136) were the strongest predictors of death/cardiac-related emergency hospital admission among demographic, clinical, and exercise variables. A VE/VCO(2) slope > or =35.4 (hazard ratio: 10.7, 95% confidence interval [CI]: 7.8 to 24.6), and a peak Vo(2)% < or =52.3% (hazard ratio: 3.4, 95% CI: 2.5 to 8.2) were associated with an increased 4-year risk of death/cardiac-related emergency hospital admission. Patients who had both a VE/VCO(2) slope > or =35.4 and a peak Vo(2)% < or =52.3% of predicted value were at highest risk (4-year event rate: 78.8%).
  
  
  CONCLUSIONS
  CPET provides important prognostic information in adults with M/S operation. Subjects with enhanced ventilatory response to exercise or those with poor exercise capacity have a substantially higher 4-year risk of death/cardiac-related emergency hospital admission.
authors.affiliation: University of Bologna, Italy. alessandro5574@iol.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giardini
authors.forename: Alfred
authors.initials: A
authors.lastname: Hager
authors.forename: Astrid E
authors.initials: AE
authors.lastname: Lammers
authors.forename: Graham
authors.initials: G
authors.lastname: Derrick
authors.forename: Jan
authors.initials: J
authors.lastname: Müller
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Dolf
authors.initials: D
authors.lastname: Odendaal
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gargiulo
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Picchio
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D016001:Confidence Intervals; D015444:Exercise; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012123:Pulmonary Ventilation; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D055815:Young Adult