CPET reference values established for asymptomatic repaired Tetralogy of Fallot patients
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Key Takeaway
Consider these CPET reference values as descriptive benchmarks for asymptomatic repaired Tetralogy of Fallot patients.
This observational cohort study aimed to establish sex- and age-specific reference values for cardiopulmonary exercise testing (CPET) in asymptomatic patients with repaired Tetralogy of Fallot (rToF). The population included 290 patients who had undergone cardiac magnetic resonance imaging and CPET on a treadmill or cycle ergometer.
The primary outcome was the establishment of reference values for ramp cycle-ergometer and treadmill CPET. For VO2 peak, the median was 26.4 mL/min/kg (interquartile range 23.0–31.5), corresponding to 72.9% of predicted (62.4–83.2). Oxygen pulse at peak was a median of 9.9 mL/beat (8.2–12.0), or 76.9% predicted (68.0–87.5). The VE/VCO2 slope at the respiratory compensation point had a median of 29.0 (26.0–32.6), and the oxygen uptake efficiency slope (OUES) was a median of 1,792.5 mL/min/log(L/min) (1,535.0–2,181.5).
Physical activity classification showed 29% of patients were sedentary, 61% moderate, and 9% high. No adverse events, discontinuations, or tolerability data were reported.
Key limitations include that it was not reported whether treadmill and cycle ergometer protocols were standardized, physical activity was assessed only by questionnaire, and future studies are needed to validate pediatric normative CPET values. The study provides reference data for clinical assessment in asymptomatic rToF patients, but it is observational and does not support causal inference.
View Original Abstract ↓
The aim of this study was to establish sex- and age-specific reference values for ramp cycle-ergometer and treadmill cardiopulmonary exercise testing (CPET) in patients with Tetralogy of Fallot (ToF). Despite successful surgical repair, residual pulmonary regurgitation remains common in repaired ToF (rToF), often leading to right or left ventricular dysfunction and reduced exercise capacity. CPET is a reliable tool for evaluating cardiopulmonary function. Although both treadmill and cycle ergometer protocols are used interchangeably, reference value ranges for each method in this population remain unclear.
CPET data were collected from asymptomatic rToF patients who had undergone cardiac magnetic resonance imaging (CMR) and performed CPET on a treadmill or cycle ergometer between 2020 and 2024. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ).
Among 290 patients, median age at CPET was 21.6 years (15.9–29.3), and median BMI was 22.5 kg/m2 (20.0–24.9). Nearly all participants (99%) were in NYHA class I. Physical activity was classified as sedentary in 29%, moderate in 61%, and high in 9%. Median VO₂ peak was 26.4 mL/min/kg (23.0–31.5), corresponding to 72.9% predicted (62.4–83.2). Median oxygen pulse at peak was 9.9 mL/beat (8.2–12.0), with 76.9% predicted (68.0–87.5). Median VE/VCO₂ slope at the respiratory compensation point was 29.0 (26.0–32.6), and median oxygen uptake efficiency slope (OUES) was 1,792.5 mL/min/log(L/min) (1,535.0–2,181.5). VO₂ peak and percent-predicted VO₂ were significantly higher with treadmill testing in both sexes (p
This study provides CPET values stratified by modality and sex in a large cohort of asymptomatic rToF patients, offering valuable reference data for clinical assessment. Future studies should validate pediatric normative CPET values through prospective, inclusive, statistically powered cohorts using standardized protocols and cross-center comparability.
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