Wikner Anna, Sandström Anette, Rinnström Daniel, Wiklund Urban, Christersson Christina, Dellborg Mikael, Nielsen Niels Erik, Sörensson Peder, Thilén Ulf, Johansson Bengt, Sandberg Camilla
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden.
JACC Adv. 2023 Jul 28;2(5):100422. doi: 10.1016/j.jacadv.2023.100422. eCollection 2023 Jul.
An association between impaired exercise capacity and risk of mortality has been reported among adults with congenital heart disease (CHD). Over the years, treatment methods have improved and may influence outcome. Hence, we report data from a national cohort reflecting a contemporary population.
The purpose of this study was to investigate the association between exercise capacity (workload) and mortality in a large registry-based cohort.
Data on exercise capacity using cycle ergometer were retrieved from the national registry of CHD. The association between predicted exercise capacity (%EC) and mortality was analyzed using Cox regression.
In total, 3,721 adults (>18 years, 44.6% women) with CHD were included. The median age was 27.0 years (IQR: 20.8-41.0 years) and mean %EC was 77% ± 20%. Over a mean follow-up of 9.4 ± 6.0 years, there were 214 (5.8%) deaths. The Multivariable Cox regression model showed that moderately and severely impaired exercise capacity (50-<70 %EC: HR: 2.1, 95% CI: 1.4-3.2, < 0.001, and <50 %EC: HR: 3.5, 95% CI: 2.1-6.0, < 0.001) and CHD complexity were associated with higher mortality (moderate complexity: HR: 1.9 95% CI: 1.2-3.0, = 0.003, great complexity: HR: 2.3 95% CI: 1.3-4.2, = 0.008) when adjusted for New York Heart Association class, physical activity, cardiovascular medication, sex, impaired systemic ventricular function, and age.
Impaired exercise capacity and CHD complexity are independently associated with all-cause mortality in patients with CHD. Exercise capacity is an easily accessible variable that may be a useful tool for risk assessment in adult patients with CHD, but this needs confirmation in prospective studies.
据报道，先天性心脏病（CHD）成人患者的运动能力受损与死亡风险之间存在关联。多年来，治疗方法不断改进，可能会影响治疗结果。因此，我们报告来自一个全国队列的数据，该队列反映了当代人群的情况。
本研究的目的是在一个基于大型注册登记的队列中调查运动能力（工作量）与死亡率之间的关联。
从全国CHD登记处检索使用自行车测力计测定运动能力的数据。使用Cox回归分析预测运动能力（%EC）与死亡率之间的关联。
总共纳入了3721例CHD成人患者（年龄>18岁，女性占44.6%）。中位年龄为27.0岁（四分位间距：20.8 - 41.0岁），平均%EC为77%±20%。在平均9.4±6.0年的随访期内，有214例（5.8%）死亡。多变量Cox回归模型显示，在调整了纽约心脏协会分级、体力活动、心血管药物治疗、性别、系统性心室功能受损和年龄后，中度和重度运动能力受损（50 - <70%EC：风险比[HR]：2.1，95%置信区间[CI]：1.4 - 3.2，P<0.001，以及<50%EC：HR：3.5，95%CI：2.1 - 6.0，P<0.001）和CHD复杂性与较高的死亡率相关（中度复杂性：HR：1.9，95%CI：1.2 - 3.0，P = 0.003，高度复杂性：HR：2.3，95%CI：1.3 - 4.2，P = 0.008）。
运动能力受损和CHD复杂性与CHD患者的全因死亡率独立相关。运动能力是一个易于获取的变量，可能是CHD成年患者风险评估的有用工具，但这需要在前瞻性研究中得到证实。
