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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: bbdas@texaschildrens.org
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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
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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