{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:37:14Z","timestamp":1781311034361,"version":"3.54.1"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,6,6]]},"abstract":"<jats:sec id=\"jah38371-sec-0001\" sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The aim of this study is to describe muscle strength in pediatric patients with repaired tetralogy of Fallot compared with healthy peers and to analyze the correlation between muscle strength and peak oxygen uptake, exercise capacity (mL\/min).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah38371-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A prospective, cross\u2010sectional study was carried out in the University Medical Center Groningen between March 2016 and December 2019, which included 8 \u2010to\u201019\u2010year\u2010old patients with repaired tetralogy of Fallot. Exclusion criteria comprised the following: Down syndrome, unstable pulmonary disease and severe scoliosis affecting pulmonary function, neuromuscular disease, and mental or physical limitations that prohibit the execution of the functional tests. Muscle strength was compared with 2 healthy pediatric cohorts from the Northern Netherlands. Handgrip strength, maximal voluntary isometric contraction, and dynamic muscle strength in correlation with peak oxygen uptake, exercise capacity (mL\/min) were the main outcomes of the study. The 67 patients with repaired tetralogy of Fallot (42% female; aged 12.9 [interquartile range, 10.0\u201316.3] years old) were compared with healthy children. The patients showed reduced grip strength (\n              <jats:italic toggle=\"no\">z<\/jats:italic>\n              \u2010score [mean\u00b1SD] \u22121.5\u00b11.2,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001), and total muscle strength (\n              <jats:italic toggle=\"no\">z<\/jats:italic>\n              \u2010score \u22120.9\u00b11.3,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001). Dynamic strength (Bruininks\u2010Oseretsky test) was significantly reduced (\n              <jats:italic toggle=\"no\">z<\/jats:italic>\n              \u2010score \u22120.3\u00b10.8,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.001), but running, speed, and agility were normal (\n              <jats:italic toggle=\"no\">z<\/jats:italic>\n              \u2010score 0.1\u00b10.7,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.4). Univariate correlation analyses showed strong correlations between absolute peak oxygen uptake, exercise capacity (mL\/min), and muscle strength (grip strength\n              <jats:italic toggle=\"no\">r<\/jats:italic>\n              =0.83, total muscle strength\n              <jats:italic toggle=\"no\">r<\/jats:italic>\n              =0.88;\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001). In multivariate analyses, including correction for age and sex, total muscle strength (B 0.3;\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.009), and forced vital capacity (B 0.5;\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.02) correlated with peak oxygen uptake, exercise capacity (mL\/min), independent of conventional cardiovascular parameters.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah38371-sec-0003\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Children with repaired tetralogy of Fallot show reduced muscle strength, which strongly correlated with their exercise performance.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.027937","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T09:52:06Z","timestamp":1684835526000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Decreased Muscle Strength in Children With Repaired Tetralogy of Fallot: Relation With Exercise Capacity"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6469-1566","authenticated-orcid":false,"given":"Grazi\u00eblla","family":"Eshuis","sequence":"first","affiliation":[{"name":"University of Groningen, University Medical Center Groningen, Beatrix Children\u2019s Hospital, Center for Congenital Heart Disease","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1682-6643","authenticated-orcid":false,"given":"Hiske","family":"van Duinen","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otto T. H. M.","family":"Lelieveld","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke K.","family":"Hegeman","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0605-9217","authenticated-orcid":false,"given":"Hessel","family":"Nijenhuis","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen, Beatrix Children\u2019s Hospital, Center for Congenital Heart Disease","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8851-0595","authenticated-orcid":false,"suffix":"MD","given":"Tineke P.","family":"Willems","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7095-514X","authenticated-orcid":false,"suffix":"MD","given":"Ann M.","family":"Hepping","sequence":"additional","affiliation":[{"name":"Roessingh Center for Rehabilitation","place":["Enschede, The Netherlands"]},{"name":"University of Groningen, University Medical Center Groningen","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6231-7044","authenticated-orcid":false,"given":"Natasha","family":"Maurits","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9247-0103","authenticated-orcid":false,"given":"Gideon J.","family":"du Marchie Sarvaas","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen, Beatrix Children\u2019s Hospital, Center for Congenital Heart Disease","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4385-5784","authenticated-orcid":false,"suffix":"MD","given":"Rolf M. 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