Assessing utility of exercise test in determining exercise prescription in adolescent and adult patients with repaired tetralogy of fallot.
Parameters from cardiopulmonary exercise test (CPET) are useful prognostic factors for patients with repaired tetralogy of fallot (TOF). Its application in exercise prescription remains unclear. This study sought to define its role. We made current exercise recommendations in repaired TOF patients according to European Society of Cardiology (ESC) guideline, which were based on ventricular function, pressure/volume load, pulmonary artery pressure, hypoxemia and arrhythmic burden both at rest and during exercise. CPET parameters (peak oxygen consumption, oxygen uptake efficiency plateau, and E/CO2slope), along with cardiothoracic ratio, ventricular arrhythmia, QRS duration and NYHA functional status, were used to calculate "score to exercise". 112 repaired TOF adolescent and adult aged 32.6 ± 10.8 (14.05- to 56.99-year-old, median 30.1) years received exercise recommendations by ESC guideline, which suggested high, moderate and low intensity sports for 45 (40.2 %), 45 (40.2 %), and 22 (19.6 %) patients, respectively. The optimal cut-off values were 67 and 77 % for peak VO2, 86 and 100 % for OUEP, 22 and 28 for E/CO2slope to correlate to the exercise intensity recommendation. But, individual CPET parameter had low consistency (41-46 %) in making decisions of exercise intensity compared to ESC recommendations. Using the "score to exercise", the consistency rate could be increased to 74.1 %. With "score to exercise" recommended exercise intensity, follow-up result revealed no adverse event related to sports. Individual CPET parameter did not correlate well to the exercise recommendation from ESC. We proposed a scoring system, "score to exercise", which incorporates three CPET parameters with cardiothoracic ratio, ventricular arrhythmia, QRS duration and NYHA functional status. Score to exercise is easy to be assessed and provides useful information for exercise recommendation in patients with repaired TOF.
Department of Pediatric Cardiology, E-DA Hospital/I-SHOU University, No. 1, Yi-Da Road, Yan-Chau District, Kaohsiung, Taiwan, ROC.|Department of Pediatric Cardiology, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC.
Ming-Chun
MC
Yang
Department of Pediatric Cardiology, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC.
Chun-An
CA
Chen
Department of Pediatric Cardiology, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC.|Department of Pediatric Cardiology, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei, Taiwan, ROC.
Hsin-Hui
HH
Chiu
Department of Pediatric Cardiology, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC.
Jou-Kou
JK
Wang
Department of Pediatric Cardiology, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC.
Ming-Tai
MT
Lin
Department of Pediatric Cardiology, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC.
Shuenn-Nan
SN
Chiu
Department of Pediatric Cardiology, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC.
Chun-Wei
CW
Lu
Department of Surgery, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC.
Shu-Chien
SC
Huang
Department of Pediatric Cardiology, National Taiwan University Children Hospital, and College of Medicine, No. 8, Chung-Shen South Road, Taipei, Taiwan, ROC. wumh@ntu.edu.tw.
Mei-Hwan
MH
Wu
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test / Q000592:standards*; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D017410:Practice Guidelines as Topic; D012372:ROC Curve; D012955:Societies, Medical; D013624:Taiwan; D013771:Tetralogy of Fallot / Q000628:therapy*; D016278:Ventricular Function, Right; D055815:Young Adult
Cardiopulmonary exercise test; E/CO2 slope; Exercise prescription; Oxygen uptake efficiency plateau; Peak oxygen consumption; Tetralogy of fallot