Wang AP;  Mayo Clinic,  Chicago, IL, USA.
Garcia C; Schellenberg D; Griffith GJ; Ward K

Pediatric Cardiology. 47(7):2796-2807, 2026 Oct.

Cardiopulmonary exercise testing (CPET) is a cornerstone of functional
assessment in congenital heart disease (CHD), yet there are additional
important contributors to exercise limitation that are not directly
measured by CPET. This narrative review highlights the complementary
utility of spirometry, body composition analysis, and evaluation of
handgrip strength in augmenting our understanding of functional capacity
in CHD. Spirometry provides insights into restrictive lung disease
patterns prevalent in post-surgical CHD populations; body composition
analysis, especially lean mass assessment, can reveal sarcopenia not
apparent using BMI alone; and handgrip strength serves as a validated
surrogate for overall muscular function and frailty. We propose routine
integration of all three testing techniques as complements to CPET
protocols to enhance clinical assessment, guide rehabilitation, and
support prognostication in pediatric CHD patients. This review advocates
for broader adoption and standardization of these measures in clinical
settings to improve risk stratification and long-term outcomes.