Cardiopulmonary exercise testing can predict outcome in paediatric CHD

Reduced exercise capacity at a young age appears to be associated with a higher likelihood of future cardiovascular events in paediatric patients with congenital heart defects (CHDs), according to a study.

For the study, researchers examined the prognostic value of cardiopulmonary exercise testing (CPET) in 411 paediatric patients (median age at test 12 years, 43 percent girls) with different CHDs. CHD was simple in 51 patients, moderately complex in 170, and highly complex in 190.

Most of the patients with simple CHD had a good physiological status (A), whereas many of the patients with moderate or high complexity CHD were in physiological stages B or C. None of the patients were in physiological stage D.

CPET parameters in the entire cohort were lower than the reference values (%predicted VO2peak, 75 percent; %predicted oxygen uptake efficiency slope [OUES], 79 percent), with patients having the most complex types of CHD having the worst exercise capacity (%predicted VO2peak, 72 percent; %predicted OUES, 75 percent).

Over a median follow-up of 28 months following CPET, 71 patients had cardiac events. This group of patients had poorer exercise performance compared with those who did not have cardiac events as determined by the submaximal variables (%predicted OUES: hazard ratio [HR], 2.6; p<0.001 and VE/VCO2: HR, 2.2; p=0.001).

The findings highlight the importance of performing CPET on a regular basis in paediatric patients with CHD.