Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan Circulation
Background Peak oxygen consumption (peak V̇$$ \dot{\mathrm{V}} $$O2) is traditionally scaled by body mass, but it is most appropriately scaled by fat‐free mass. However, it is unknown whether peak V̇$$ \dot{\mathrm{V}} $$O2 scaled by fat‐free mass is associated with mortality and morbidity in people...
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Wiley
2024-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.034944 |
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| author | Curtis A. Wadey Alan R. Barker A. Graham Stuart Dan‐Mihai Dorobantu Guido E. Pieles Derek L. Tran Karina Laohachai Julian Ayer Rob G. Weintraub Rachael Cordina Craig A. Williams |
| author_facet | Curtis A. Wadey Alan R. Barker A. Graham Stuart Dan‐Mihai Dorobantu Guido E. Pieles Derek L. Tran Karina Laohachai Julian Ayer Rob G. Weintraub Rachael Cordina Craig A. Williams |
| author_sort | Curtis A. Wadey |
| collection | DOAJ |
| description | Background Peak oxygen consumption (peak V̇$$ \dot{\mathrm{V}} $$O2) is traditionally scaled by body mass, but it is most appropriately scaled by fat‐free mass. However, it is unknown whether peak V̇$$ \dot{\mathrm{V}} $$O2 scaled by fat‐free mass is associated with mortality and morbidity in people with a Fontan circulation. The aim of this study was to assess the associations between different expressions of peak V̇$$ \dot{\mathrm{V}} $$O2 with mortality and morbidity in people with a Fontan circulation. Methods and Results Eighty‐seven participants (aged 24.1±7.3 years; 53% women) with a Fontan circulation completed a cardiopulmonary exercise test and a dual‐energy x‐ray absorptiometry scan. Cox proportional hazard regressions models assessed the association (hazard ratio [HR]) between different expressions of peak V̇$$ \dot{\mathrm{V}} $$O2 with a composite outcome of Fontan failure (FF). Participants were followed up for a median of 6.5 years (95% CI, 6.4–6.9). Individuals experiencing FF (n=10/87) had a significantly lower absolute peak V̇$$ \dot{\mathrm{V}} $$O2. In univariable models, peak V̇$$ \dot{\mathrm{V}} $$O2 ratio scaled to body mass was not significantly associated with FF (HR, 0.91; P=0.111). However, peak V̇$$ \dot{\mathrm{V}} $$O2 scaled by fat‐free mass (HR, 0.90; P=0.020) or lean mass (HR, 0.90; P=0.017) was significantly and inversely associated with FF. These associations remained significant after adjusting for age, sex, and peak respiratory exchange ratio. Conclusions The association between peak V̇$$ \dot{\mathrm{V}} $$O2 and FF is improved when scaled to measures of body composition. Applied clinically, a 1‐unit increase in peak V̇$$ \dot{\mathrm{V}} $$O2 scaled to fat‐free mass or lean mass is associated with a ≈10% lower risk of FF. |
| format | Article |
| id | doaj-art-d6e76c9c6ae1419dbfd2f97c037b9007 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-d6e76c9c6ae1419dbfd2f97c037b90072024-12-17T12:51:22ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-12-01132410.1161/JAHA.123.034944Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan CirculationCurtis A. Wadey0Alan R. Barker1A. Graham Stuart2Dan‐Mihai Dorobantu3Guido E. Pieles4Derek L. Tran5Karina Laohachai6Julian Ayer7Rob G. Weintraub8Rachael Cordina9Craig A. Williams10Children’s Health & Exercise Research Centre (CHERC) Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter Exeter United KingdomChildren’s Health & Exercise Research Centre (CHERC) Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter Exeter United KingdomBristol Congenital Heart Centre The Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust Bristol United KingdomChildren’s Health & Exercise Research Centre (CHERC) Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter Exeter United KingdomBristol Congenital Heart Centre The Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust Bristol United KingdomCentral Clinical School, The University of Sydney Camperdown New South Wales AustraliaCentral Clinical School, The University of Sydney Camperdown New South Wales AustraliaCentral Clinical School, The University of Sydney Camperdown New South Wales AustraliaDepartment of Cardiology Royal Children’s Hospital Melbourne Victoria AustraliaCentral Clinical School, The University of Sydney Camperdown New South Wales AustraliaChildren’s Health & Exercise Research Centre (CHERC) Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter Exeter United KingdomBackground Peak oxygen consumption (peak V̇$$ \dot{\mathrm{V}} $$O2) is traditionally scaled by body mass, but it is most appropriately scaled by fat‐free mass. However, it is unknown whether peak V̇$$ \dot{\mathrm{V}} $$O2 scaled by fat‐free mass is associated with mortality and morbidity in people with a Fontan circulation. The aim of this study was to assess the associations between different expressions of peak V̇$$ \dot{\mathrm{V}} $$O2 with mortality and morbidity in people with a Fontan circulation. Methods and Results Eighty‐seven participants (aged 24.1±7.3 years; 53% women) with a Fontan circulation completed a cardiopulmonary exercise test and a dual‐energy x‐ray absorptiometry scan. Cox proportional hazard regressions models assessed the association (hazard ratio [HR]) between different expressions of peak V̇$$ \dot{\mathrm{V}} $$O2 with a composite outcome of Fontan failure (FF). Participants were followed up for a median of 6.5 years (95% CI, 6.4–6.9). Individuals experiencing FF (n=10/87) had a significantly lower absolute peak V̇$$ \dot{\mathrm{V}} $$O2. In univariable models, peak V̇$$ \dot{\mathrm{V}} $$O2 ratio scaled to body mass was not significantly associated with FF (HR, 0.91; P=0.111). However, peak V̇$$ \dot{\mathrm{V}} $$O2 scaled by fat‐free mass (HR, 0.90; P=0.020) or lean mass (HR, 0.90; P=0.017) was significantly and inversely associated with FF. These associations remained significant after adjusting for age, sex, and peak respiratory exchange ratio. Conclusions The association between peak V̇$$ \dot{\mathrm{V}} $$O2 and FF is improved when scaled to measures of body composition. Applied clinically, a 1‐unit increase in peak V̇$$ \dot{\mathrm{V}} $$O2 scaled to fat‐free mass or lean mass is associated with a ≈10% lower risk of FF.https://www.ahajournals.org/doi/10.1161/JAHA.123.034944cardiorespiratory fitnessCox regressionfractional polynomialsprognosistotal cavopulmonary circulation |
| spellingShingle | Curtis A. Wadey Alan R. Barker A. Graham Stuart Dan‐Mihai Dorobantu Guido E. Pieles Derek L. Tran Karina Laohachai Julian Ayer Rob G. Weintraub Rachael Cordina Craig A. Williams Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan Circulation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiorespiratory fitness Cox regression fractional polynomials prognosis total cavopulmonary circulation |
| title | Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan Circulation |
| title_full | Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan Circulation |
| title_fullStr | Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan Circulation |
| title_full_unstemmed | Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan Circulation |
| title_short | Peak Oxygen Consumption Scaled to Body Composition Is Associated With Mortality and Morbidity in People With a Fontan Circulation |
| title_sort | peak oxygen consumption scaled to body composition is associated with mortality and morbidity in people with a fontan circulation |
| topic | cardiorespiratory fitness Cox regression fractional polynomials prognosis total cavopulmonary circulation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.034944 |
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