FitzMaurice Thomas Simon, Hawkes Scott, Liao Yuen, Cullington Damien, Bryan Angella, Redfern James, Ashrafi Reza
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.
Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
Int J Cardiol Congenit Heart Dis. 2024 Sep 29;18:100546. doi: 10.1016/j.ijcchd.2024.100546. eCollection 2024 Dec.
Assessment of exercise capacity by cardiopulmonary exercise testing (CPET) in adults with congenital heart disease (CHD) is important for prognostication and preoperative assessment. Peak oxygen uptake (PVO) is used commonly, but can be challenging due to the difficulties of undertaking maximal CPET testing in this population. We explored whether oxygen uptake efficiency slope (OUES) at ventilatory anaerobic threshold (VAT), the point during CPET at which OUES becomes strongly correlated with PVO, and is more reliably available from submaximal CPET, can predict PVO in adults with CHD.
We assessed consecutive individuals who completed maximal CPET at our cardiorespiratory centre, as part of routine service review, between March 2019 and August 2021, recording data such as PVO, VAT and OUES at various proportions of a maximal test (75 %, 90 %, 100 %, and VAT). We employed linear regression modelling to analyse the association between PVO and OUES at VAT, and subsequently create an equation to predict PVO from OUES at VAT. Parametric data are presented using Pearson's correlation coefficient and non-parametric data using Spearman's rho.
We analysed 391 individuals (177 female, age 32 ± 11 years). Mean ± SD PVO was 23.3 ± 6.86 ml/min/kg or 1724 ± 540 ml/min, peak VE 86.7 ± 25.4 l/min. The point of VAT as a percentage of PVO achieved was 66.5 ± 9.4 %, and VAT as a percentage of predicted PVO 46.9 ± 11.4 %. PVO was correlated with OUES at 100 % (R = 0.91, P < .001), 90 % (R = 0.91, P < .001), 75 % (R = 0.89, P < .001) of maximum, and VAT (R = 0.83, P < .001). PVO could be predicted by: .
OUES at VAT can be used to calculate PVO. To our knowledge, this is the first equation using OUES at VAT to predict PVO in adults with CHD. In a population who may find maximal CPET difficult, this may be a useful submaximal measurement of cardiovascular fitness, and to calculate PVO, which is commonly used in guideline-based decision making in CHD.
对于先天性心脏病（CHD）成人患者，通过心肺运动试验（CPET）评估运动能力对预后和术前评估很重要。峰值摄氧量（PVO）是常用指标，但由于该人群进行最大CPET测试存在困难，这一指标的获取具有挑战性。我们探讨了在通气无氧阈（VAT）时的摄氧效率斜率（OUES），即在CPET过程中OUES与PVO变得高度相关且可从次最大CPET更可靠获得的点，是否能预测CHD成人患者的PVO。
我们评估了2019年3月至2021年8月期间在我们心肺中心完成最大CPET的连续患者，作为常规服务评估的一部分，记录了最大测试不同比例（75%、90%、100%和VAT）时的PVO、VAT和OUES等数据。我们采用线性回归模型分析VAT时PVO与OUES之间的关联，随后创建一个根据VAT时的OUES预测PVO的方程。参数数据用Pearson相关系数表示，非参数数据用Spearman秩相关系数表示。
我们分析了391例患者（177例女性，年龄32±11岁）。平均±标准差PVO为23.3±6.86 ml/min/kg或1724±540 ml/min，峰值每分钟通气量（VE）为86.7±25.4 l/min。VAT占达到的PVO的百分比为66.5±9.4%，VAT占预测PVO的百分比为46.9±11.4%。PVO与最大测试的100%（R = 0.91，P <.001）、90%（R = 0.91，P <.001）、75%（R = 0.89，P <.001）时的OUES以及VAT时的OUES（R = 0.83，P <.001）相关。PVO可通过以下公式预测： 。
VAT时的OUES可用于计算PVO。据我们所知，这是首个使用VAT时的OUES预测CHD成人患者PVO的方程。在可能难以进行最大CPET的人群中，这可能是一种有用的次最大心血管适能测量方法，用于计算PVO，而PVO常用于CHD基于指南决策制定中。
