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Impaired exercise capacity and mortality risk in adults with congenital heart disease
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0001-8443-9149
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0002-3350-9001
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.ORCID iD: 0000-0002-6712-7693
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.ORCID iD: 0000-0002-1313-0934
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2023 (English)In: JACC: Advances, ISSN 2772-963X, Vol. 2, no 5, p. 100422-100422, article id 100422Article in journal (Refereed) Published
Abstract [en]

Background: An association between impaired exercise capacity and risk of mortality has been reported among adults with congenital heart disease (CHD). Over the years, treatment methods have improved and may influence outcome. Hence, we report data from a national cohort reflecting a contemporary population.

Objectives: The purpose of this study was to investigate the association between exercise capacity (workload) and mortality in a large registry-based cohort.

Methods: Data on exercise capacity using cycle ergometer were retrieved from the national registry of CHD. The association between predicted exercise capacity (%ECpred) and mortality was analyzed using Cox regression.

Results: In total, 3,721 adults (>18 years, 44.6% women) with CHD were included. The median age was 27.0 years (IQR: 20.8-41.0 years) and mean %ECpred was 77% ± 20%. Over a mean follow-up of 9.4 ± 6.0 years, there were 214 (5.8%) deaths. The Multivariable Cox regression model showed that moderately and severely impaired exercise capacity (50-<70 %ECpred: HR: 2.1, 95% CI: 1.4-3.2, P < 0.001, and <50 %ECpred: HR: 3.5, 95% CI: 2.1-6.0, P < 0.001) and CHD complexity were associated with higher mortality (moderate complexity: HR: 1.9 95% CI: 1.2-3.0, P = 0.003, great complexity: HR: 2.3 95% CI: 1.3-4.2, P = 0.008) when adjusted for New York Heart Association class, physical activity, cardiovascular medication, sex, impaired systemic ventricular function, and age.

Conclusions: Impaired exercise capacity and CHD complexity are independently associated with all-cause mortality in patients with CHD. Exercise capacity is an easily accessible variable that may be a useful tool for risk assessment in adult patients with CHD, but this needs confirmation in prospective studies.

Place, publisher, year, edition, pages
Elsevier, 2023. Vol. 2, no 5, p. 100422-100422, article id 100422
Keywords [en]
aerobic exercise capacity, congenital heart disease, exercise test, mortality, outcome
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-215208DOI: 10.1016/j.jacadv.2023.100422Scopus ID: 2-s2.0-85179944904OAI: oai:DiVA.org:umu-215208DiVA, id: diva2:1804302
Funder
Swedish Heart Lung Foundation, 20200493Swedish Heart Lung Foundation, 20190525Swedish Heart Lung Foundation, 20170483Swedish Heart Lung Foundation, 20130472Swedish Heart Lung Foundation, 20100355Umeå UniversityRegion VästerbottenVisare NorrAvailable from: 2023-10-11 Created: 2023-10-11 Last updated: 2024-01-12Bibliographically approved

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Wikner, AnnaSandström, AnetteRinnström, DanielWiklund, UrbanJohansson, BengtSandberg, Camilla

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Wikner, AnnaSandström, AnetteRinnström, DanielWiklund, UrbanChristersson, ChristinaJohansson, BengtSandberg, Camilla
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Department of Public Health and Clinical MedicineDepartment of Surgical and Perioperative SciencesRadiation PhysicsDepartment of Community Medicine and Rehabilitation
Cardiac and Cardiovascular Systems

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