Novel techniques for quantifying oxygen pulse curve characteristics during cardiopulmonary exercise testing in tetralogy of fallot

Cardiopulmonary exercise testing (CPET) is used in evaluation of repaired tetralogy of Fallot (rTOF), particularly for pulmonary valve replacement need. Oxygen pulse (O2P) is the CPET surrogate for stroke volume and peripheral oxygen extraction. This study assessed O2P curve properties against non-invasive cardiac output monitoring (NICOM) and clinical testing. This cross-sectional study included 44 rTOF patients and 10 controls. Three new evaluations for O2P curve analysis during CPET were developed. Best fit early and late regression slopes of the O2P curve were used to calculate: 1) the early to late ratio, or “O2 pulse response ratio” (O2PRR); 2) the portion of exercise until slope inflection, or “flattening fraction” (FF); 3) the area under the O2P response curve, or “O2P curve area”. rTOF patients (median age 35.2 (27.6–39.4); 61% female) had a lower VO2 max (23.4 vs 45.6 ml/kg/min; p