Key result
Using new paediatric VO2max Z-score equations, overweight or obese children with congenital heart disease had significantly lower aerobic fitness than matched controls (Z-score -0.43 vs -0.01; P=0.02).
Why the study?
Interpreting CPET in overweight or obese children with CHD is challenging because VO2max is influenced by both the cardiac condition and BMI.
Do new paediatric VO2max Z-score reference equations better discriminate aerobic fitness in overweight/obese children with congenital heart disease compared to controls?
Cross-Sectional (n=344)
Do new paediatric VO2max Z-score reference equations better discriminate aerobic fitness in overweight/obese children with congenital heart disease compared to controls?
Absolute Event Rate: -0.43% vs -0.01%
p-value: p=0.02
The new paediatric VO2max Z-score equations effectively discriminate aerobic fitness impairment in overweight/obese children with congenital heart disease compared to controls, unlike traditional linear models.
New Z-score equations may better detect impaired fitness in overweight CHD children than linear models; extends reference data but leaves open prospective validation before clinical adoption.
AIMS: Overweight and obesity in children with congenital heart disease (CHD) represent an alarming cardiovascular risk. Promotion of physical activity and cardiac rehabilitation in this population requires assessing the level of aerobic fitness (VO2max) by a cardiopulmonary exercise test (CPET). Nevertheless, the interpretation of CPET in overweight/obese children with CHD remains challenging as VO2max is affected by both the cardiac condition and the body mass index (BMI). The new paediatric VO2max Z-score reference equations, based on a logarithmic function of VO2max, height and BMI, were applied to overweight/obese children with a CHD and compared with overweight/obese children without any other chronic condition. METHODS AND RESULTS: In this cross-sectional controlled study, 344 children with a BMI > 85th percentile underwent a CPET (54% boys; mean age 11.5 ± 3.1 years; 100 CHD; 244 controls). Using the VO2max Z-score equations, aerobic fitness was significantly lower in obese/overweight CHD children than that in matched obese/overweight control children (-0.43 ± 1.27 vs. -0.01 ± 1.09; P = 0.02, respectively), and the proportion of children with impaired aerobic fitness was significantly more important in obese/overweight CHD children than in matched controls (17% vs.6%, P = 0.02, respectively). The paediatric VO2max Z-score reference equations also identified specific complex CHD at risk of aerobic fitness impairment (univentricular heart and right outflow tract anomalies). Using Cooper's weight- and height-based linear equations, similar matched-comparisons analyses found no significant group differences. CONCLUSIONS: As opposed to the existing linear models, the new paediatric VO2max Z-score equations can discriminate the aerobic fitness of obese/overweight children with CHD from that of obese/overweight children without any chronic disease. REGISTRATION: ClinicalTrials.gov NCT04815577.
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Amédro et al. (2023) conducted a cross-sectional in Overweight or obese children with congenital heart disease (n=344). Congenital heart disease vs. Overweight/obese children without chronic conditions was evaluated on Aerobic fitness (VO2max Z-score) (p=0.02). Using new paediatric VO2max Z-score equations, overweight or obese children with congenital heart disease had significantly lower aerobic fitness than matched controls (Z-score -0.43 vs -0.01; P=0.02).
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