Open Access

ARTICLE

Predictive Value of Echocardiography Combined with Cardiopulmonary Exercise Testing for Functional Status and Adverse Outcomes of Adult Patients with Congenital Heart Disease

Ling Lin, Yasha Liang, Yunyu Chen, Rong Su, Hu Zhang, Ailing Yang^*

The First Affiliated Hospital of Kunming Medical University, Kunming, 650034, China

* Corresponding Author: Ailing Yang. Email:

Congenital Heart Disease 2025, 20(6), 703-716. https://doi.org/10.32604/chd.2025.072819

Received 04 September 2025; Accepted 15 December 2025; Issue published 10 February 2026

Abstract

Background: We aimed to explore the value of echocardiography plus cardiopulmonary exercise testing (CPET) for predicting the functional status and adverse outcomes of adult patients with congenital heart disease (CHD), and to develop a multivariate prediction model. Methods: Subjects (135 in total) in this single-center prospective cohort study were enrolled from adult patients suffering from CHD treated in this hospital during January 2021 and August 2023. Standardized echocardiography and CPET were conducted on all subjects at enrollment, with such indicators as left ventricular ejection fraction (LVEF), right ventricular function parameters, peak oxygen uptake (peak VO₂), and carbon dioxide ventilatory equivalent slope [ventilation (VE)/carbon dioxide output (VCO₂) slope] recorded. Results: In contrast with the non-event group, the event group exhibited higher levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and lower LVEF and peak VO₂ (p < 0.05). Four key predictors (age, NT-proBNP, LVEF and peak VO₂) were acquired after Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis. According to Cox analysis, age and NT-proBNP served as risk factors, while LVEF and peak VO₂ acted as protective factors (p < 0.05). As to the Logistic model, its area under curve (AUC) was 0.920, the mean AUC in cross-validation was 0.919, and the SHAPLEY Additive exPlanations (SHAP) analysis results were in line with the Cox model. Conclusions: Echocardiography plus CPET is capable of effectively forecasting the functional status and adverse outcomes of adult CHD patients, and the key independent predictors are age, NT-proBNP, LVEF and peak VO₂.

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