Eshuis Graziella, Hock Julia, Marchie du Sarvaas Gideon, van Duinen Hiske, Neidenbach Rhoia, van den Heuvel Freek, Hillege Hans, Berger Rolf Mf, Hager Alfred
Center of Congenital Heart Disease, Department of Paediatric Cardiology, Beatrix Children's Hospital, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
Department of Paediatric Cardiology and Congenital Heart Disease, Technical University Munich, German Heart Centre Munich, München, Germany.
Heart. 2022 Feb;108(3):186-193. doi: 10.1136/heartjnl-2020-318928. Epub 2021 May 14.
This study aimed to provide a perspective for the interpretation of exercise capacity (peakVO) in patients with repaired Tetralogy of Fallot (patients with rTOF) by describing the course of peakVO from patients aged 6-63 years.
A retrospective study was performed between September 2001 and December 2016 in the German Heart Centre Munich, Germany, and in the University Medical Centre Groningen, the Netherlands. A total of 1175 cardiopulmonary exercise tests (CPETs) were collected from 586 patients with rTOF, 46% female. Maximal exertion was verified using a respiratory exchange ratio ≥1.00. PeakVO was modelled using time-dependent multilevel models for repeated measurements (n=889 in 300 patients), and compared with subject-specific reference values calculated by the models of Bongers and Mylius RESULTS: The peakVO of patients with rTOF was reduced at all ages. At the age of 6, the peakVO was 614 mL/min (70% of predicted (95% CI 67 to 73)). The reduced increase in peakVO during adolescence resulted in a significant lower maximum peakVO of 1209 mL/min at 25 years (65% predicted, p<0.001). A linear decline after 25 years was observed in patients and references, although patients showed an accelerated decline, with a -0.24% point of predicted (95% CI 0.11 to 0.38) per year without differences between sexes (p=0.263).
This study provides a context for peakVO across ages in patients with rTOF under contemporary treatment strategies. It showed that the reduction in peakVO originates from childhood and declines over time. Sex differences in patients with rTOF were similar to natural existing sex differences.
本研究旨在通过描述6至63岁法洛四联症修复术后患者（rTOF患者）的峰值摄氧量（peakVO₂）变化过程，为解读该类患者的运动能力（peakVO₂）提供一个视角。
2001年9月至2016年12月在德国慕尼黑心脏中心和荷兰格罗宁根大学医学中心进行了一项回顾性研究。共收集了586例rTOF患者的1175次心肺运动试验（CPET），其中46%为女性。使用呼吸交换率≥1.00来验证最大运动量。采用时间依赖性多水平模型对重复测量数据（300例患者中的889次测量）进行peakVO₂建模，并与Bongers和Mylius模型计算出的个体特异性参考值进行比较。结果：rTOF患者在各年龄段的peakVO₂均降低。6岁时，peakVO₂为614 mL/min（预测值的70%，95%CI为67至73）。青春期peakVO₂增长减少导致25岁时最大peakVO₂显著降低，为1209 mL/min（预测值的65%，p<0.001）。25岁后患者和参考值均呈线性下降，尽管患者下降加速，每年下降预测值的-0.24%（95%CI为0.11至0.38），且性别间无差异（p=0.263）。
本研究为当代治疗策略下rTOF患者各年龄段的peakVO₂提供了一个背景情况。研究表明，peakVO₂的降低始于儿童期，并随时间推移而下降。rTOF患者的性别差异与自然存在的性别差异相似。
