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Longitudinal Exercise Capacity of Patients With Repaired Tetralogy of Fallot
Open accessAbstract
Patients with repaired tetralogy of Fallot have a reduced percentage of predicted peak oxygen consumption (VO(2)) and percentage of oxygen pulse (O(2)P%) compared to healthy controls. Because data regarding the progression of exercise intolerance in these patients is limited, we sought to analyze the serial exercise data from patients with Tetralogy of Fallot to quantify the changes in their exercise capacity over time and to identify associations with clinical and cardiac magnetic resonance imaging variables. The data from cardiopulmonary exercise tests (CPXs) from 2002 to 2010 for patients with repaired tetralogy of Fallot with ≥2 CPXs separated by ≥12 months were analyzed. Tests occurring after interventional catheterization or surgery were excluded. A total of 70 patients had 179 CPXs. They had a median age at the initial study of 23.6 years and an interval between the first and last CPX of 2.8 years. At the initial CPX, the peak VO(2) was 27.6 ± 8.8 ml/kg/min (78 ± 19% of predicted), and the peak O(2)P% was 89 ± 22% of predicted. At the most recent study, the peak VO(2) averaged 25.0 ± 7.4 ml/kg/min (73 ± 16% of predicted), and the peak O(2)P% averaged 83 ± 20% (p <0.01) for each versus the initial CPX. The decrease in the peak VO(2) was strongly associated with a decrease in O(2)P% and an increase (worsening) in the slope of the minute ventilation-versus-carbon dioxide production relation. Changes in the peak VO(2) did not correlate with concomitant changes in any other CPX variable. The rate of decrease was not related to a history of shunt palliation, age at CPX, or any other baseline clinical parameter, including cardiac magnetic resonance measurements. In conclusion, the exercise capacity of patients with repaired tetralogy of Fallot tends to decrease over time. This deterioration is variable and unpredictable and is primarily related to a decrease in the forward stroke volume at peak exercise.
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“A certain degree of exercise intolerance has been reported in most patients with rTOF, and this seems to worsen over time [77,78].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [77]
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Mercer‐Rosa, L., Parnell, A. S., Forfia, P. R., Yang, W. P., Goldmuntz, E., & Kawut, S. M. (2013) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2013.06.022 · Cited by 93
Comparison of Management Strategies for Neonates With Symptomatic Tetralogy of Fallot
Goldstein, B. H., Petit, C. J., Qureshi, A. M., McCracken, C., Kelleman, M. S., Nicholson, G. T., Law, M. A., Meadows, J. J., Zampi, J. D., Shahanavaz, S., et al. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.12.048 · Cited by 80
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Self-citation22q11.2 Deletion Status and Disease Burden in Children and Adolescents With Tetralogy of Fallot
Mercer‐Rosa, L., Paridon, S. M., Fogel, M. A., Rychik, J. R., Tanel, R. E., Zhao, H., Zhang, X., Yang, W. P., Justine Shults, A., & Goldmuntz, E. (2015) · Circulation Cardiovascular Genetics · doi:10.1161/circgenetics.114.000819 · Cited by 55
Natural history of exercise function in patients with Ebstein anomaly: A serial study
Kipps, A. K., Graham, D. A., Lewis, E. E., Marx, G. R., Banka, P., & Rhodes, J. (2012) · American Heart Journal · doi:10.1016/j.ahj.2011.12.006 · Cited by 42
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Metadata
- Authors
- Kipps, A. K., Graham, D. A., Harrild, D. M., Lewis, E., Powell, A. J., & Rhodes, J.
- Affiliations
- University of California, San Francisco (US)
- Boston Children's Hospital (US)
- Corresponding author
- Kipps, Alaina K.
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2011-07
- Volume
- 108
- Issue
- 1
- Pages
- 99-105
- ISSN
- 0002-9149 (ISSN-L)
- PMC
- PMC7091494
- OpenAlex
- W2162171163
- Cited by
- 65
- References
- 30
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 7 · 2020: 5 · 2019: 2 · 2018: 5 · 2017: 1 · 2016: 2 · 2015: 6 · 2014: 1 · 2013: 8 · 2012: 4
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL007572)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- repaired tetralogy of Fallot, exercise capacity, peak oxygen uptake, oxygen pulse, exercise intolerance, cardiopulmonary exercise testing, stroke volume, cardiac magnetic resonance imaging
- MeSH terms
- Adolescent, Child, Child, Preschool, Exercise Test, Female, Follow-Up Studies, Cardiac Catheterization, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Male, Oxygen Consumption, Prognosis, Retrospective Studies, Tetralogy of Fallot, Exercise Tolerance, Young Adult
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