TY - JOUR
T1 - Strong and independent prognostic value of peak circulatory power in adults with congenital heart disease
AU - Giardini, Alessandro
AU - Specchia, Salvatore
AU - Berton, Emanuela
AU - Sangiorgi, Diego
AU - Coutsoumbas, Gloria
AU - Gargiulo, Gaetano
AU - Oppido, Guido
AU - Bonvicini, Marco
AU - Picchio, Fernando M.
PY - 2007/9
Y1 - 2007/9
N2 - Background: The identification of patients with adult congenital heart disease (ACHD) who are at higher risk of death is challenging. Peak circulatory power (CircP; expressed as peak exercise oxygen uptake multiplied for peak mean arterial blood pressure) is a strong predictor of death in adults with acquired heart disease. We sought to establish the distribution and the prognostic value of peak CircP across a wide spectrum of patients with ACHD. Methods: Four hundred thirty-two consecutive patients with ACHD of varying diagnosis underwent cardiopulmonary exercise testing at a single laboratory between 1996 and 2005. Patient age was 32 ± 10 years. Results: A gradual variation in peak CircP was found across the spectrum of congenital heart defects (P <.0001 at analysis of variance). Reduced peak CircP values were associated with the presence of heart failure symptoms (P <.0001), absence of sinus rhythm (P = .010), and use of antiarrhythmic medications (P = .0013). At a follow-up of 4.4 ± 2.4 years, 23 patients (5.3%) had died. Peak CircP was a strong predictor of mortality when univariate analysis was used and the strongest independent predictor of mortality among exercise parameters. A peak CircP ≤1476 mm Hg mlO2 min-1 kg-2 was associated with a 15.4-fold increase in the 4-year risk of death. Conclusions: Peak CircP is abnormal across the spectrum of ACHD. Peak CircP appears as the strongest predictor of adverse outcome in ACHD.
AB - Background: The identification of patients with adult congenital heart disease (ACHD) who are at higher risk of death is challenging. Peak circulatory power (CircP; expressed as peak exercise oxygen uptake multiplied for peak mean arterial blood pressure) is a strong predictor of death in adults with acquired heart disease. We sought to establish the distribution and the prognostic value of peak CircP across a wide spectrum of patients with ACHD. Methods: Four hundred thirty-two consecutive patients with ACHD of varying diagnosis underwent cardiopulmonary exercise testing at a single laboratory between 1996 and 2005. Patient age was 32 ± 10 years. Results: A gradual variation in peak CircP was found across the spectrum of congenital heart defects (P <.0001 at analysis of variance). Reduced peak CircP values were associated with the presence of heart failure symptoms (P <.0001), absence of sinus rhythm (P = .010), and use of antiarrhythmic medications (P = .0013). At a follow-up of 4.4 ± 2.4 years, 23 patients (5.3%) had died. Peak CircP was a strong predictor of mortality when univariate analysis was used and the strongest independent predictor of mortality among exercise parameters. A peak CircP ≤1476 mm Hg mlO2 min-1 kg-2 was associated with a 15.4-fold increase in the 4-year risk of death. Conclusions: Peak CircP is abnormal across the spectrum of ACHD. Peak CircP appears as the strongest predictor of adverse outcome in ACHD.
UR - http://www.scopus.com/inward/record.url?scp=34547958186&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34547958186&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2007.05.009
DO - 10.1016/j.ahj.2007.05.009
M3 - Article
C2 - 17719287
AN - SCOPUS:34547958186
VL - 154
SP - 441
EP - 447
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 3
ER -