An adult with congenital heart disease may experience exercise intolerance, even if asymptomatic at rest. A number of findings may identify a patient at increased risk. The authors are from Royal Brompton Hospital, Imperial College and St. Mary's Hospital in London.

Patient selection: adult with congenital heart disease


Predictors of exercise intolerance:

(1) lack of heart rate response to exercise

(2) pulmonary arterial hypertension

(3) impaired pulmonary function (FEV1, cyanosis)

(4) underlying cardiac anatomy (Eisenmenger, complex anatomy, congenitally corrected transposition of the great arteries, ASD late closure, other)

(5) higher NYHA class

(6) obesity


A patient with exercise intolerance had a reduced peak oxygen consumption during exercise testing. Reduced exercise tolerance was associated with hospitalization and death.


Predictors of hospitalization or death on multivariate analysis:

(1) NYHA class

(2) peak VO2


Peak VO2

Freedom Hospitalization or Death at 1.5 Years

< 15.5 mL/kg/min


15.5 to 27 mL/kg/min


> 27 mL/kg/min



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