Peak oxygen uptake, ventilatory efficiency and QRS-duration predict event free survival in patients late after surgical repair of tetralogy of Fallot
Open accessAbstract
Objective Patients with repaired tetralogy of Fallot (ToF) have an increased long-term risk of cardiovascular morbidity and mortality. Risk stratification in this population is difficult. Initial evidence suggests that cardiopulmonary exercise testing (CPET) may be helpful to risk-stratify patients with repaired ToF.Methods and results We studied 875 patients after surgical repair for ToF (358 females, age 25.5 ± 11.7 year, range 7-75 years) who underwent CPET between 1999 and 2009. During a mean follow-up of 4.1 ± 2.6 years after CPET, 30 patients (3.4%) died or had sustained ventricular tachycardia (VT). 225 patients (25.7%) had other cardiac related events (emergency admission, surgery, or catheter interventions). On multivariable Cox regression-analysis, %predicted peak oxygen uptake (V˙O2 %) (p=0.001), resting QRS duration (p=0.030) and age (p<0.001) emerged as independent predictors of mortality or sustained VT. Patients with a peak V˙O2 ≤ 65% of predicted and a resting QRS duration ≥ 170 ms had a 11.4-fold risk of death or sustained VT. Ventilatory efficiency expressed as V˙E/V˙CO2 slope (p<0.001), peak V˙O2 % (p=.001), QRS duration (p=.001) and age (p=0.046) independently predicted event free survival. V˙E/V˙CO2 slope ≥ 31.0, peak V˙O2 % ≤ 65% and QRS duration ≥ 170 ms were the cut-off points with best sensitivity and specificity to detect an unfavorable outcome.Conclusions CPET is an important predictive tool that may assist in the risk stratification of patients with ToF. Subjects with a poor exercise capacity in addition to a prolonged QRS duration have a substantially increased risk for death or sustained ventricular tachycardia, as well as for cardiac-related hospitalizations.
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Peak VO2 or its predicted value, VE/VCO2 slope, and OUES seem to be predictive of death, event-free survival, and/or cardiac hospitalisations in repaired TOF.
“Overall, peak VO2 or its predicted value, VE/VCO2 slope, and OUES seem to be predictive of death, event-free survival, and/or cardiac hospitalisations [95,101,102,103].”
From Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up (2023) · cites this paper as [95]
The Abstract (page unavailable) reports that predicted peak VO₂ and the VE/VCO₂ slope predict outcomes in patients with repaired tetralogy of Fallot, including death or sustained ventricular tachycardia and event-free survival. The Discussion (page unavailable) also links these measures to cardiac morbidity. The paper does not report OUES as a predictor, so that part of the multi-citation claim is not supported by this source. (LLM, conf=0.88)
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Cites
Gatzoulis, M. A., Balaji, S., Webber, S. A., Siu, S. C., Hokanson, J. S., Poile, C., Rosenthal, M., Nakazawa, M., Moller, J. H., Gillette, P. C., et al. (2000) · The Lancet · doi:10.1016/s0140-6736(00)02714-8 · Cited by 1,779 · see citing works
Self-citationLong-term outcome in patients undergoing surgical repair of tetralogy of Fallot
Murphy, J. G., Gersh, B. J., Mair, D. D., Fuster, V., McGoon, M. D., Ilstrup, D. M., McGoon, D. C., Kirklin, J. W., & Danielson, G. K. (1993) · New England Journal of Medicine · doi:10.1056/nejm199308263290901 · Cited by 998 · see citing works
Diller, G.-P., Dimopoulos, K., Okonko, D., Li, W., Babu-Narayan, S. V., Broberg, C. S., Johansson, B., Bouzas, B., Mullen, M. J., Poole-Wilson, P. A., et al. (2005) · Circulation · doi:10.1161/circulationaha.104.529800 · Cited by 878 · see citing works
Self-citationMechanoelectrical Interaction in Tetralogy of Fallot
Gatzoulis, M. Α., Till, J. A., Somerville, J., & Redington, A. N. (1995) · Circulation · doi:10.1161/01.cir.92.2.231 · Cited by 781 · see citing works
Self-citationNollert, G., Fischlein, T., Bouterwek, S., Böhmer, C., Klinner, W., & Reichart, B. (1997) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(97)00318-5 · Cited by 761 · see citing works
Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair
Therrien, J., Provost, Y. L., Merchant, N., Williams, W. G., Colman, J. M., & Webb, G. D. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2004.11.037 · Cited by 662 · see citing works
Oosterhof, T. H., van Straten, A., Vliegen, H. W., Meijboom, F. J., van Dijk, A. P. J., Spijkerboer, A. M., Bouma, B. J., Zwinderman, A. H., Hazekamp, M. G., Roos, A., et al. (2007) · Circulation · doi:10.1161/circulationaha.106.659664 · Cited by 610 · see citing works
Implantable Cardioverter-Defibrillators in Tetralogy of Fallot
Khairy, P., Harris, L., Landzberg, M. J., Viswanathan, S., Barlow, A., Gatzoulis, M. Α., Fernandes, S. M., Beauchesne, L., Therrien, J., Chétaille, P., et al. (2008) · Circulation · doi:10.1161/circulationaha.107.726372 · Cited by 559 · see citing works
Self-citationTherrien, J., Siu, S. C., McLaughlin, P. R., Liu, P. P., Williams, W. G., & Webb, G. D. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00930-x · Cited by 540 · see citing works
Valente, A. M., Gauvreau, K., Assenza, G. E., Babu‐Narayan, S. V., Schreier, J., Gatzoulis, M. Α., Groenink, M., Inuzuka, R., Kilner, P. J., Koyak, Z., et al. (2013) · Heart · doi:10.1136/heartjnl-2013-304958 · Cited by 501 · see citing works
Self-citationKnauth, A. L., Gauvreau, K., Powell, A. J., Landzberg, M. J., Walsh, E. P., Lock, J. E., del Nido, P. J., & Geva, T. (2006) · Heart · doi:10.1136/hrt.2006.104745 · Cited by 496 · see citing works
Therrien, J., Siu, S. C., Harris, L., Dore, A., Niwa, K., Janoušek, J., Williams, W. G., Webb, G. D., & Gatzoulis, M. Α. (2001) · Circulation · doi:10.1161/01.cir.103.20.2489 · Cited by 467 · see citing works
Self-citationDiller, G., Giardini, A., Dimopoulos, K., Gargiulo, G., Müller, J., Derrick, G. P., Giannakoulas, G. A., Khambadkone, S., Lammers, A. E., Picchio, F. M., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq356 · Cited by 357 · see citing works
Self-citationDimopoulos, K., Okonko, D. O., Diller, G., Broberg, C. S., Salukhe, T. V., Babu‐Narayan, S. V., Li, W., Uebing, A. S., Bayne, S., Wensel, R., et al. (2006) · Circulation · doi:10.1161/circulationaha.105.594218 · Cited by 312 · see citing works
Self-citationReoperation in adults with repair of tetralogy of Fallot: indications and outcomes.
Oechslin, E. N., Harrison, D. A., Harris, L., Downar, E., Webb, G. D., Siu, S. S., & Williams, W. G. (1999) · The Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(99)70214-x · Cited by 264 · see citing works
Heart Rate Response During Exercise Predicts Survival in Adults With Congenital Heart Disease
Diller, G., Dimopoulos, K., Okonko, D. O., Uebing, A. S., Broberg, C. S., Babu‐Narayan, S. V., Bayne, S., Poole-Wilson, P. A., Sutton, R., Francis, D. P., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.05.051 · Cited by 237 · see citing works
Self-citationGas Exchange Response to Exercise in Children
Cooper, D. M., & Weiler‐Ravell, D. (1984) · American Review of Respiratory Disease · doi:10.1164/arrd.1984.129.2p2.s47 · Cited by 164 · see citing works
Giardini, A., Specchia, S., Tacy, T. A., Coutsoumbas, G., Gargiulo, G., Donti, A., Formigari, R., Bonvicini, M., & Picchio, F. M. (2007) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2006.12.076 · Cited by 160 · see citing works
Self-citationMüller, J., Christov, F., Schreiber, C., et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp305 · Cited by 148 · see citing works
Self-citationGiardini, A., Hager, A., Lammers, A. E., Derrick, G. P., Müller, J., Diller, G., Dimopoulos, K., Odendaal, D., Gargiulo, G., Picchio, F. M., et al. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.02.005 · Cited by 141 · see citing works
Self-citationTwenty-to-thirty-seven-year follow-up after repair for Tetralogy of Fallot.
Nørgaard, M. A., Lauridsen, P., Helvind, M., & Pettersson, G. (1999) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/s1010-7940(99)00137-2 · Cited by 134 · see citing works
Early Versus Late Functional Outcome After Successful Percutaneous Pulmonary Valve Implantation
Lurz, P. C., Nordmeyer, J., Giardini, A., Khambadkone, S., Muthurangu, V., Schievano, S., Thambo, J., Walker, F., Cullen, S., Derrick, G. P., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.07.056 · Cited by 132 · see citing works
Self-citationQuantitative assessment by Doppler echocardiography of pulmonary or aortic regurgitation
Goldberg, S. J., & Allen, H. D. (1985) · The American Journal of Cardiology · doi:10.1016/0002-9149(85)90581-8 · Cited by 108 · see citing works
Timing and type of surgery for severe pulmonary regurgitation after repair of tetralogy of Fallot
Davlouros, P. A., Karatza, A., Gatzoulis, M. Α., & Shore, D. F. (2004) · International Journal of Cardiology · doi:10.1016/j.ijcard.2004.08.013 · Cited by 104 · see citing works
Self-citationMeasures of exercise capacity in adults with congenital heart disease
Buys, R., Cornelissen, V., Bruaene, A. V. D., Stevens, A., Coeckelberghs, E., Onkelinx, S., Thomaes, T., Delecluse, C., Budts, W., & Vanhees, L. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2010.08.030 · Cited by 95 · see citing works
Self-citationFollow-Up After Pulmonary Valve Replacement in Adults With Tetralogy of Fallot
Scherptong, R. W. C., Hazekamp, M. G., Mulder, B. J. M., Wijers, O., Swenne, C. A., van der Wall, E. E., Schalij, M. J., & Vliegen, H. W. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.04.058 · Cited by 82 · see citing works
Ventricular arrhythmias and biventricular dysfunction after repair of tetralogy of Fallot
Kavey, R.-E. W., Thomas, F. D., Byrum, C. J., et al. (1984) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(84)80329-0 · Cited by 73 · see citing works
Lurz, P. C., Giardini, A., Taylor, A. M., Nordmeyer, J., Muthurangu, V., Odendaal, D., Mist, B., Khambadkone, S., Schievano, S., Bonhoeffer, P., et al. (2010) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.10.054 · Cited by 67 · see citing works
Self-citationOosterhof, T. H., Vliegen, H. W., Meijboom, F. J., Zwinderman, A. H., Bouma, B. J., & Mulder, B. J. M. (2006) · Heart · doi:10.1136/hrt.2006.094169 · Cited by 66 · see citing works
Risk factors for sudden death after repair of tetralogy of Fallot
Nollert, G., Däbritz, S., Schmoeckel, M., Vicol, C., & Reichart, B. (2003) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(03)01065-8 · Cited by 62 · see citing works
Müller, J., Hess, J., & Hager, A. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2010.04.005 · Cited by 54 · see citing works
Self-citationExercise Testing and Interpretation: A Practical Approach
Devanathan, S. (2002) · CHEST Journal · doi:10.1378/chest.122.1.388-a · Cited by 51 · see citing works
Adults with Tetralogy of Fallot: Long-Term Follow-up
HOKANSON, J. S., & MOLLER, J. H. (1999) · Cardiology in Review · doi:10.1097/00045415-199905000-00012 · Cited by 30 · see citing works
Predictors of mid-term event-free survival in adults with corrected tetralogy of Fallot
Buys, R., Bruaene, A. V. D., Meester, P. D., Budts, W., & Vanhees, L. (2012) · Acta Cardiologica · doi:10.1080/ac.67.4.2170682 · Cited by 17 · see citing works
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Pulmonary Valve Replacement in Tetralogy of Fallot: An Updated Meta-Analysis
Van den Eynde, J., Sá, M. P. B. O., Vervoort, D., Roever, L., Meyns, B., Budts, W., Gewillig, M., Ruhparwar, A., Zhigalov, K., & Weymann, A. (2022) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2020.11.040 · Cited by 62 · see citing works
Multimodality imaging assessment of tetralogy of Fallot: From diagnosis to long-term follow-up
Moscatelli, S., Pergola, V., Motta, R., Fortuni, F., Borrelli, N., Sabatino, J., Leo, I., Avesani, M., Montanaro, C., Surkova, E., et al. (2023) · Children · doi:10.3390/children10111747 · Cited by 17 · see citing works
- Authors
- Müller, J., Hager, A., Diller, G.-P., Derrick, G., Buys, R., Dubowy, K.-O., Takken, T., Orwat, S., Inuzuka, R., Vanhees, L., Gatzoulis, M., & Giardini, A.
- Affiliations
- Deutsches Herzzentrum München (DE)
- Royal Brompton Hospital (GB)
- Great Ormond Street Hospital (GB)
- KU Leuven (BE)
- Heart and Diabetes Center North Rhine-Westphalia (DE)
- University Medical Center Utrecht (NL)
- University Hospital Münster (DE)
- Corresponding author
- Müller, Jan
- ORCID
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 196
- Pages
- 158-164
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W1683030484
- Cited by
- 113
- References
- 34
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 15 · 2023: 13 · 2022: 9 · 2021: 8 · 2020: 11 · 2019: 9 · 2018: 15 · 2017: 10 · 2016: 4 · 2015: 1
- FWCI
- 7.84
- Type
- journal article
- Language
- en
- Open access
- green
- lirias.kuleuven.be
- Licence
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- Japan Society for the Promotion of Science (26860784)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- repaired tetralogy of Fallot, peak oxygen uptake, ventilatory efficiency, QRS duration, cardiopulmonary exercise testing, risk stratification, event-free survival, ventricular tachycardia, mortality, exercise capacity
- MeSH terms
- Adolescent, Adult, Aged, Child, Electrocardiography, Exercise Test, Female, Humans, Male, Middle Aged, Oxygen Consumption, Pulmonary Ventilation, Retrospective Studies, Risk Factors, Tetralogy of Fallot, Exercise Tolerance, Tachycardia, Ventricular, Disease-Free Survival, Young Adult
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