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Original article
Functional outcome in contemporary children and young adults with tetralogy of Fallot after repair
  1. Julia Hock1,
  2. Anna-Luisa Häcker1,2,
  3. Barbara Reiner2,
  4. Renate Oberhoffer1,2,
  5. Alfred Hager1,
  6. Peter Ewert1,
  7. Jan Müller2
  1. 1Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munchen, Germany
  2. 2Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
  1. Correspondence to Julia Hock, Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, 80636, Germany; jhock{at}gmx.net

Abstract

Objective Functional outcome measures are of growing importance in the aftercare of patients with congenital heart disease. This study addresses the functional status with regard to exercise capacity, health-related physical fitness (HRPF) and arterial stiffness in a recent cohort of children, adolescents and young adults with tetralogy of Fallot (ToF) after repair.

Design Single-centre, uncontrolled and prospective cohort study.

Setting Outpatient department of the German Heart Centre Munich; July 2014–January 2018.

Patients One hundred and six patients with ToF after repair (13.5±3.7 years, 40 females) were included. Data were compared with a recent cohort of healthy controls (HCs) (n=1700, 12.8±2.6 years, 833 females).

Main outcome measures Patients underwent a symptom-limited cardiopulmonary exercise test, performed an HRPF test (FitnessGram) and had an assessment of their arterial stiffness (Mobil-O-Graph).

Results Compared with HC, patients with ToF showed lower predicted Embedded ImageO2 peak (ToF: 80.4% ± 16.8% vs HC: 102.6% ± 18.1%, p<0.001), impaired ventilatory efficiency (ToF: 29.6 ± 3.6 vs HC: 27.4 ± 2.9, p<0.001), chronotropic incompetence (ToF: 167 ± 17 bpm vs HC: 190 ± 17 bpm, p<0.001) and reduced HRPF (ToF z-score: −0.65 ± 0.87 vs HC z-score: 0.03 ± 0.65, p<0.001). Surrogates of arterial stiffness, central and peripheral systolic blood pressure, did not differ between the two groups.

Conclusions Contemporary children, adolescents and young adults with ToF still have functional limitations. How impaired HRPF and limited exercise capacity interact and how they can be modified needs to be evaluated in further intervention studies.

  • central blood pressure
  • fitness
  • congenital heart disease
  • fallot
  • exercise capacity

http://dx.doi.org/10.1136/archdischild-2017-314733

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    Footnotes

    • Contributors JH was responsible for sampling data, analysing them and drafting the manuscript. A-LH and BR also sampled data in the study centre. RO, AH and PE gave important input for drafting and revising the manuscript. JM was responsible for conception and design of the study and gave important input for drafting and revising the manuscript.

    • Funding This study was funded by an unrestricted grant from the ’Fördergemeinschaft Deutsche Kinderherzzentren e.V.'.

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Ethics approval The study was approved by the local ethical board of the Technical University of Munich (project number: 314/14).

    • Provenance and peer review Not commissioned; externally peer reviewed.