Key result
Children with repaired congenital heart disease and residual lesions had lower maximal aerobic capacity than healthy controls (76.1% vs 86% of theoretical value, p<0.01).
Why the study?
Children with repaired CHD have impaired VO2max, but determining the causes of their VO2max alteration remains challenging.
Does cardiac output measurement during CPET identify the determinants of impaired VO2max in children with repaired congenital heart disease compared to healthy controls?
Observational (n=121)
Does cardiac output measurement during CPET identify the determinants of impaired VO2max in children with repaired congenital heart disease compared to healthy controls?
Absolute Event Rate: 76.1% vs 86%
p-value: p=< 0.01
Measuring cardiac output during CPET in children with repaired CHD helps differentiate central versus peripheral causes of impaired aerobic capacity, guiding interventions and rehabilitation.
Impaired aerobic capacity in repaired CHD with residuals warrants clinical exercise assessment; leaves open determinants identifiable by cardiac output during CPET.
Background Children with repaired congenital heart disease (CHD) have impaired maximal aerobic capacity (VO2max). Determining the causes of their VO2max alteration remains challenging. Cardiac output measure using thoracic impedancemetry during cardiopulmonary exercise tests (CPET) can help to understand the determinants of VO2max in children with open-heart repaired CHD. Method We analyzed CPET in 77 children with repaired CHD. Among them, 55 patients had residual lesions. Patients with repaired CHD were compared with 44 age-matched healthy individuals. Maximal oxygen content brought to capillaries (QO2max) and oxygen muscle diffusion capacity (DO2) were assessed using cardiac output measure, Fick principle and simplified Fick law. Results In the 55 patients with residual lesion, VO2max, QO2max and DO2 were lower than those of controls (76.1 vs 86% of theoretical value, p < 0.01; 2.15 vs 2.81 L/mn, p < 0.001; 24.7 vs 28.8 ml/min/mmHg, p < 0.05). Decrease in QO2max was due to both impaired stroke volume and chronotropic insufficiency (48 vs 53 ml/m 2 and p < 0.05; 171 vs 185/min p < 0.001). Patients without residual lesion (22/77) had normal VO2max with lower maximal heart rate compensated by higher SV (p < 0.05). Conclusion Aerobic capacity was normal in children without residual lesions after CHD repair. Patients with residual lesion have impaired VO2max due to both lower central and peripheral determinants. Measuring cardiac performance during CPET allowed a better selection of patients with altered cardiac reserve that can benefit from residual lesion treatment and find the good timing for intervention. Detection of peripheral deconditioning can lead to a rehabilitation program.
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Guirgis et al. (2019) conducted an observational in Repaired congenital heart disease (n=121). Repaired congenital heart disease with residual lesions vs. Age-matched healthy individuals was evaluated on Maximal aerobic capacity (VO2max) as percentage of theoretical value (p=< 0.01). Children with repaired congenital heart disease and residual lesions had lower maximal aerobic capacity than healthy controls (76.1% vs 86% of theoretical value, p<0.01).
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