Abstract
Prior to the 1990s, d-TGA was palliated with the atrial switch procedure resulting in a systemic right ventricle associated with significant long-term morbidity and mortality. Determining the optimal timing of heart transplantation (HT) in these patients has been difficult. While cardiopulmonary exercise testing (CPET) is commonly used to try and risk stratify these patients, traditional exercise parameters have lacked the sensitivity and specificity to assess long-term risk. We sought to assess changes in exercise parameters over time in order to determine if any CPET parameter or combination of parameters could reliably identify risk for adverse outcome in this patient group. A retrospective review of serial CPET for 40 patients over 17 years was completed. Patients with adverse event within 6 months prior to CPET were noted. CPET parameters were compared and linear mixed model regression with repeated measures was performed on serial tests for longitudinal assessment. The linear mixed model regression identified OUES indexed to BSA to be the most sensitive parameter in identifying patients at risk of adverse event and became a stronger predictor of adverse event when combined with peak heart rate. CPET is useful in identifying patients with atrial switch at increased risk of adverse outcome. Indexed OUES and peak heart rate are better prognostic indicators than VO2 and VE/VCO2.
Similar content being viewed by others
Data Availability
N/A.
Code Availability
N/A.
References
Raissadati A, Nieminen H, Sairanen H, Jokinen E (2017) Outcomes after the Mustard, Senning and arterial switch operation for treatment of transposition of the great arteries in Finland: a nationwide 4-decade perspective. Eur J Cardiothorac Surg 52:573–580
Vejlstrup N, Sorensen K, Mattsson E et al (2015) Long-term outcome of Mustard/Senning correction for transposition of the great arteries in Sweden and Denmark. Circulation 132:633–638
Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR (1991) Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 83:778–786
Osada N, Chaitman BR, Miller LW et al (1998) Cardiopulmonary exercise testing identifies low risk patients with heart failure and severely impaired exercise capacity considered for heart transplantation. J Am Coll Cardiol 31:577–582
Das BB, Taylor AL, Boucek MM, Wolfe RW, Yetman AT (2006) Exercise capacity in pediatric heart transplant candidates: is there any role for the 14 ml/kg/min guideline? Pediatr Cardiol 27:226–229
Paridon SM, Alpert BS, Boas SR et al (2006) Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the young, committee on atherosclerosis, hypertension, obesity and youth. Circulation 113(15):1905–1920
Yetman AT, King S, Bornemeier RA, Fasules J (2002) Comparison of exercise performance in patients after pulmonary valvulotomy for pulmonary stenosis and tetralogy of Fallot. Am J Cardiol 90:1412–1414
Ramos RP, Ota-Arakaki JS, Alencar MC, Ferreira EV, Nery LE, Neder JA (2014) Exercise oxygen upteak efficiency slope independently predicts poor outcome in pulmonary arterial hypertension. Eur Respir J 43:1510–1512
Malhotra R, Bakken K, D’Elia E, Lewis GD (2016) Cardiopulmonary exercise testing in heart failure. JACC Heart Fail 4:607–616
Inuzuka R, Diller GP, Borgia F et al (2012) Comprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term. Circulation 125:250–259
Giardini A (2009) Ventilatory efficiency and aerobic capacity predict event-free survival in adults with atrial repair for complete transposition of the great arteries. J Am Coll Cardiol 53:1548–1555
Reich O, Voriskova M, Ruth C et al (1997) Long-term ventricular performance after intra-atrial correction of transposition: left ventricular filling is the major limitation. Heart 78:376–381
Silove ED, Taylor JF (1976) Haemodynamics after Mustard’s operation for transposition of the great arteries. Br Heart J 38:1037–1046
Eicken A, Michel J, Hager A et al (2017) Limited ventricular preload is the main reason for reduced stress reserve after atrial baffle repair. Pediatr Cardiol 38:353–361
Iriart X, Le Quellenec S, Pillois X et al (2020) Heart rate response during exercise predicts exercise tolerance in adults with transposition of the great arteries and atrial switch operation. Int J Cardiol 299:116–122
Rog B, Salapa K, Okolska M et al (2019) Clinical evaluation of exercise capacity in adults with systemic right ventricle. Tex Heart Inst J 46:14–20
Chaix MA, Dore A, Mercier LA et al (2017) Late onset postcapillary pulmonary hypertension in patients with transposition of the great arteries and Mustard or Senning baffles. J Am Heart Assoc. https://doi.org/10.1161/JAHA.117.006481
Buys R, Coeckelberghs E, Vanhees L, Cornelissen VA (2014) The oxygen efficiency slope in 1411 Caucasian healthy men and women aged 20–60 years: reference values. Eur J Prevent Cardiol 22(3):356–363
Funding
No funding was received to assist with the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
All authors made substantial contributions to the study conception and design. Material preparation, data collection, and analysis were performed by all. The first draft of the manuscript was written by Dr. KA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
None of the authors have any financial or non-financial conflicts of interest to disclose.
Ethical Approval
This retrospective study received institutional IRB approval through University of Nebraska. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed Consent
A waiver of consent was granted.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Aarsvold, K.J., Danford, D.A. & Yetman, A.T. Oxygen Uptake Efficiency Slope Predicts Adverse Outcome Following Atrial Switch Procedure. Pediatr Cardiol 43, 561–566 (2022). https://doi.org/10.1007/s00246-021-02756-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-021-02756-1