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
50%
15.5 to 27 mL/kg/min
63%
> 27 mL/kg/min
97%
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