Soares Andrea, Park Lauren K, Mansour Emily, Deych Elena, Puritz Alyssa, Zhao Min, Cao Chao, Coggan Andrew R, Barger Phillip M, Foraker Randi, Racette Susan B, Peterson Linda R
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
Am J Cardiol. 2025 Aug 15;249:29-35. doi: 10.1016/j.amjcard.2025.04.020. Epub 2025 Apr 24.
Peak oxygen consumption (V̇O) is used to predict outcomes and time to transplantation in patients with heart failure with reduced ejection fraction (HFrEF); V̇O also has predictive utility in patients with adult congenital heart disease (ACHD). However, the predictive value of a given V̇O on cardiac events in patients with ACHD compared to HFrEF, especially after adjustment for age and sex, is unclear. Therefore, we performed a longitudinal cohort study comparing patients with ACHD to patients with HFrEF. The cohorts were sex and age matched (±10 years). V̇O tests were conducted from 1993 to 2012. Cardiac events included death, cardiac transplantation, and LVAD placement. Events were obtained via electronic medical record, SSDI, and phone interview. Cox proportional-hazard regression analyses were used to evaluate relationships of event-free survival with predictor variables. Patients with ACHD (N = 137) and HFrEF (N = 137) had median follow-up times of 19.0 years (14.8 to 21.1) and 14.5 years (13.4 to 15.6), respectively. In multivariable models, Higher V̇O was associated with lower risk for a cardiac event, independent of age and sex, in both ACHD (HR 0.89, 95% CI 0.83 to 0.96, p = 0.002) and HFrEF (HR 0.86, 95% CI 0.82 to 0.91, p <0.001). Male sex was associated with greater risk of a cardiac event HFrEF (HR 1.90, 95% CI 1.24 to 2.90, p = 0.003) but not in ACHD group. After multivariable adjustment (Beta-blockers, sex, and V̇O), having ACHD conferred a 71% lower risk of cardiac events compared to a HFrEF diagnosis (HR 0.29, 95% CI 0.18 to 0.47, p <0.001). V̇O independently predicts event-free survival among adults with ACHD or HFrEF and has clinical utility in outpatient settings. Patients with ACHD have a better prognosis after multivariable adjustment including V̇O compared to HFrEF.
峰值耗氧量（V̇O）用于预测射血分数降低的心力衰竭（HFrEF）患者的预后和移植时间；V̇O在成人先天性心脏病（ACHD）患者中也具有预测作用。然而，与HFrEF相比，特定V̇O对ACHD患者心脏事件的预测价值尚不清楚，尤其是在调整年龄和性别之后。因此，我们进行了一项纵向队列研究，比较ACHD患者和HFrEF患者。队列在性别和年龄上匹配（±10岁）。V̇O测试于1993年至2012年进行。心脏事件包括死亡、心脏移植和左心室辅助装置植入。事件通过电子病历、社会安全死亡指数（SSDI）和电话访谈获得。采用Cox比例风险回归分析来评估无事件生存与预测变量之间的关系。ACHD患者（N = 137）和HFrEF患者（N = 137）的中位随访时间分别为19.0年（14.8至21.1年）和14.5年（13.4至15.6年）。在多变量模型中，较高的V̇O与ACHD（风险比[HR] 0.89，95%置信区间[CI] 0.83至0.96，p = 0.002）和HFrEF（HR 0.86，95% CI 0.82至0.91，p <0.001）患者发生心脏事件的较低风险相关，且独立于年龄和性别。男性与HFrEF患者发生心脏事件的风险更高相关（HR 1.90，95% CI 1.24至2.90，p = 0.003），但在ACHD组中并非如此。在多变量调整（β受体阻滞剂、性别和V̇O）后，与HFrEF诊断相比，患有ACHD使心脏事件风险降低71%（HR 0.29，95% CI 0.18至0.47，p <0.001）。V̇O独立预测ACHD或HFrEF成人患者的无事件生存，并且在门诊环境中具有临床实用性。与HFrEF相比，在包括V̇O在内的多变量调整后，ACHD患者的预后更好。
