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Does Restrictive Lung Function Affect the Exercise Capacity in Patients with Repaired Tetralogy of Fallot?

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Abstract

Patients with repaired Tetralogy of Fallot (rTOF) have decreased exercise capacity (XC) and restrictive lung function (RLF). Our objective was to determine the association between RLF and impaired XC in patients with rTOF. This was a single center retrospective review of patients with rTOF who underwent a cardiopulmonary treadmill exercise testing and spirometry from 2005 to 2015. Patients with a respiratory exchange ratio ≥ 1.05 and peak heart rate > 90% of predicted value were included. Forced vital capacity (FVC) and Forced expiratory volume in 1st second of forceful expiration (FEV1) were used to classify the lung function. Exercise parameters such as peak oxygen uptake (VO2), % of predicted VO2 (%VO2), Metabolic equivalents (METS), and exercise time (ET) were compared between the two groups (i) compared patients with normal lung function (normal FEV1, FVC, and FEV1/FVC > 80%) (ii) RLF (FVC < 80%, normal or increased FEV1/FVC > 80%). In our cohort (n = 151, 52% male, mean age ± SD of 22.3 ± 9.1 years), patients with RLF (n = 73) compared to those with normal lung function (n = 86) had a lower peak VO2 (30.8 ± 8.6 vs. 36.6 ± 9.8 mL/kg/min; p < 0.001) and shorter exercise time (9:23 ± 1:78 vs. 10:23 ± 1:62 min, p < 0.001). On multivariate regression analysis, RLF was independently associated with reduced XC (VO2%) (β-coefficient − 0.182, p < 0.02) after controlling for age and gender. RLF is common in patients with rTOF and is associated with decreased XC. The contribution of RLF to reduced XC in this population should be considered prior to therapeutic decisions.

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Abbreviations

TOF:

Tetralogy of Fallot

CHD:

Congenital heart disease

XC:

Exercise capacity

VO2 :

Volume of oxygen uptake

PV:

Pulmonary valve

RV:

Right ventricle

FVC:

Forced vital capacity

RLF:

Restrictive lung function

HR:

Heart rate

BP:

Blood pressure

SpO2 :

Pulse oximetry

VCO2 :

Volume of CO2 elimination

VE:

Minute ventilation

MVV:

Maximum voluntary ventilation

VAT:

Ventilatory anaerobic threshold

TV:

Tidal volume

METS:

Metabolic equivalents of task

ET:

Exercise time

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, The Carman and Ann Adams, Wayne State University School of Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI, USA

    Jyothsna Akam-Venkata, Chenni Sriram, Michelle French, Roxann Smith & Sanjeev Aggarwal

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  1. Jyothsna Akam-Venkata
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Correspondence to Jyothsna Akam-Venkata.

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This article does not contain any studies with human participants or animals performed by any of the authors. The study was approved by the Wayne State University School of Medicine and Detroit Medical Center Institutional Review Board.

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Akam-Venkata, J., Sriram, C., French, M. et al. Does Restrictive Lung Function Affect the Exercise Capacity in Patients with Repaired Tetralogy of Fallot?. Pediatr Cardiol 40, 1688–1695 (2019). https://doi.org/10.1007/s00246-019-02205-0

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