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Geng L, Huang S, Zhang T, Li J, Wang L, Zhou J, Gao L, Wang Y, Li J, Guo W, Li Y, Zhang Q. The association between O 2-pulse slope ratio and functional severity of coronary stenosis: A combined cardiopulmonary exercise testing and quantitative flow ratio study. IJC HEART & VASCULATURE 2024; 52:101409. [PMID: 38646188 PMCID: PMC11033149 DOI: 10.1016/j.ijcha.2024.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/23/2024]
Abstract
Background The role of cardiopulmonary exercise testing (CPET) parameters in evaluating the functional severity of coronary disease remains unclear. The aim of this study was to quantify the O2-pulse morphology and investigate its relevance in predicting the functional severity of coronary stenosis, using Murray law-based quantitative flow ratio (μQFR) as the reference. Methods CPET and μQFR were analyzed in 138 patients with stable coronary artery disease (CAD). The O2-pulse morphology was quantified through calculating the O2-pulse slope ratio. The presence of O2-pulse plateau was defined according to the best cutoff value of O2-pulse slope ratio for predicting μQFR ≤ 0.8. Results The optimal cutoff value of O2-pulse slope ratio for predicting μQFR ≤ 0.8 was 0.4, with area under the curve (AUC) of 0.632 (95 % CI: 0.505-0.759, p = 0.032). The total discordance rate between O2-pulse slope ratio and μQFR was 27.5 %, with 13 patients (9.4 %) being classified as mismatch (O2-pulse slope ratio > 0.4 and μQFR ≤ 0.8) and 25 patients being classified as reverse-mismatch (O2-pulse slope ratio ≤ 0.4 and μQFR > 0.8). Angiography-derived microvascular resistance was independently associated with mismatch (OR 0.07; 95 % CI: 0.01-0.38, p = 0.002) and reverse-mismatch (OR 9.76; 95 % CI: 1.47-64.82, p = 0.018). Conclusion Our findings demonstrate the potential of the CPET-derived O2-pulse slope ratio for assessing myocardial ischemia in stable CAD patients.
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Affiliation(s)
- Liang Geng
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Shangwei Huang
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
- Department of Cardiology, Shanghai East Hospital JI'AN Hospital, Ji'an, Jiangxi 343000, China
| | - Tingting Zhang
- Department of Biomedical Engineering, College of Medicine, Kyung Hee University, Seoul 02447, South Korea
| | - Jimin Li
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Lijie Wang
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Junyan Zhou
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Liming Gao
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Yunkai Wang
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Jiming Li
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Wei Guo
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Ying Li
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Qi Zhang
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
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Rückert J, Michaelis A, Markel F, Kalden P, Löffelbein F, Klehs S, Dähnert I, Schöffl I, Rottermann K, Paech C. Open Field Exercise Testing in Pediatric Congenital Heart Disease Patients: A Subsumption of Cardiovascular Parameters. Pediatr Cardiol 2023; 44:1831-1838. [PMID: 37486362 PMCID: PMC10520100 DOI: 10.1007/s00246-023-03226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/02/2023] [Indexed: 07/25/2023]
Abstract
Heart failure is a common phenomenon in congenital heart disease patients. Cardiopulmonary exercise testing is used for a reliable assessment of heart failure but is still challenging, especially for young children. Implementing mobile cardiopulmonary exercise testing (CPET) can close that diagnostic gap. While average values for healthy children have already been published, this study aims to describe typical ranges of cardiovascular performance parameters of young children with congenital heart disease performing an 8-min running cardiopulmonary exercise test. Children aged 4-8 years with common congenital heart defects after corrective surgery (Tetralogy of Fallot; transposition of the great arteries and univentricular hearts after palliation) were included. The outdoor running protocol consisted of slow walking, slow jogging, fast jogging, and maximum speed running. Each exercise was performed for 2 min, except the last, in which children were instructed to keep up maximal speed as long as possible. A total of 78 children (45 male/33 female, mean age 6,24) with congenital heart disease participated in the study, of which 97% completed the CPET successfully. A detailed description of participating patients, including data on cardiac function and subjective fitness levels, is given to help physicians use this method to classify their patients. This study presents a typical range for cardiovascular performance parameters in a population of 4-8-year-old children with congenital heart disease tested in a newly developed outdoor running protocol for CPET.
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Affiliation(s)
- J. Rückert
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
| | - A. Michaelis
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
| | - F. Markel
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
| | - P. Kalden
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
| | - F. Löffelbein
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
| | - S. Klehs
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
| | - I. Dähnert
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
| | - I. Schöffl
- Department of Pediatric Cardiology, University Hospital Erlangen, Loschbergstraße 15, 91054 Erlangen, Germany
| | - K. Rottermann
- Department of Pediatric Cardiology, University Hospital Erlangen, Loschbergstraße 15, 91054 Erlangen, Germany
| | - C. Paech
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
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Leonardi B, Cifra B. The Role of Cardiopulmonary Testing to Risk Stratify Tetralogy of Fallot Patients. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:314-321. [PMID: 38161674 PMCID: PMC10755826 DOI: 10.1016/j.cjcpc.2023.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024]
Abstract
Neonatal repair has completely changed the clinical history of patients with tetralogy of Fallot (ToF); however, these patients carry a significant risk of severe arrhythmias and sudden cardiac death in the long term. The exact mechanism for late sudden cardiac death is multifactorial and still not well defined, and the risk stratification for primary prophylaxis in these patients remains challenging. Cardiopulmonary exercise testing (CPET) is a well-established and safe method to assess cardiopulmonary function in children and adults with congenital heart disease. Several parameters obtained with CPET have been identified as potential prognostic of major adverse cardiovascular events in congenital heart disease. CPET is routinely used to assess functional capacity also in patients with ToF, and there is some evidence showing its usefulness in predicting the cardiac adverse events in patients with repaired ToF. Current guidelines recognize the importance of CPET in the evaluation and management of patients with ToF, but there is no clear consensus on which the CPET parameter or level of exercise intolerance, as measured by CPET, is truly predictive of an increased risk of arrhythmia and major adverse cardiovascular events in this population. Therefore, the aim of this narrative review is to describe the current evidence on the potential use of CPET in the risk stratification of patients with repaired ToF.
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Affiliation(s)
- Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Hospital, IRCCS, Rome, Italy
| | - Barbara Cifra
- Division of Cardiology, Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Ontario, Canada
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