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McDonald JA, Ye XT, Jones B, Zannino D, Konstantinov I, Brink J, Brizard C, d'Udekem Y. Exercise Capacity and Reoperation Late After Transatrial Fallot Repair. Heart Lung Circ 2024; 33:1209-1214. [PMID: 38755045 DOI: 10.1016/j.hlc.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 01/21/2024] [Accepted: 03/31/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The exercise capacity long after repair of tetralogy of Fallot, when performed exclusively with a transatrial repair, is unclear. It is also unknown whether echocardiography and cardiopulmonary exercise testing can predict the risk of reoperation in this patient group. METHOD We retrospectively reviewed the clinical records of 59 patients who underwent cardiopulmonary exercise testing after transatrial Fallot repair at a single centre. Patients underwent cardiopulmonary exercise testing at a mean age of 16.6±4.4 years, and at 15.3±4.1 years after Fallot repair. RESULTS At testing, the volume of oxygen consumption at maximal exercise (VO2 max) was 71%±13% and the oxygen pulse was 80%±17% of predicted values. Seventeen (17) patients (29%) had a VO2 max superior to 80% of the predicted value. Thirty-two (32) patients (56%) had severe pulmonary regurgitation, three (5%) had moderate pulmonary regurgitation, and 12 (21%) had mild pulmonary regurgitation. After a mean of 7.8±3.9 years following cardiopulmonary exercise testing (23±5.3 years after the repair), 21 (40%) patients underwent reoperation. Right ventricular dilation and systolic function on echocardiography were both significantly associated with subsequent reoperation rates. Patients who had severe right ventricular dilation were eight times more likely to undergo subsequent reoperation (hazard ratio 8.67; 1.82-41.3; p=0.007). No cardiopulmonary exercise testing variable independently predicted reoperation. CONCLUSIONS The exercise capacity at adolescence following transatrial repair of tetralogy of Fallot is maintained at around 70% of predicted values. Only the patients with normal right ventricular size and normal right ventricular function seemed to be protected from reoperation over the subsequent decade. We found no exercise variables which predicted reoperation.
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Affiliation(s)
- Jodie A McDonald
- Department of Paediatrics, The University of Melbourne, Parkville, Vic, Australia
| | - Xin Tao Ye
- Department of Paediatrics, The University of Melbourne, Parkville, Vic, Australia
| | - Bryn Jones
- Department of Cardiology, Royal Children's Hospital Melbourne, Parkville, Vic, Australia
| | - Diana Zannino
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, Vic, Australia
| | - Igor Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, Vic, Australia
| | - Johann Brink
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, Vic, Australia
| | - Christian Brizard
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, Vic, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital Melbourne, Parkville, Vic, Australia.
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Fillies B, Stapel B, Lemke LH, Löffler F, Bauersachs J, Kahl KG, Westhoff-Bleck M. Remission from depression is associated with improved quality of life and preserved exercise capacity in adults with congenital heart disease. Front Cardiovasc Med 2024; 11:1418342. [PMID: 39022619 PMCID: PMC11251921 DOI: 10.3389/fcvm.2024.1418342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Aims Improved long-term survival has widened the treatment goals for adults with congenital heart disease (ACHD) by addressing parameters that impact mental well-being and exercise capacity. Depression, a frequent co-morbidity in ACHD, is linked to both. Whether successful treatment of depression also affects cardiac parameters is a matter of debate. Methods This prospective, cross-sectional, longitudinal study included N = 150 ACHD (mean age 35.2 ± 11.3 years, 57% male) at baseline (t0) and N = 114 at follow-up (mean follow-up: 4.8 ± 0.6 years; t1). Patients were interviewed using a structured clinical interview, and severity of depression was assessed using the Montgomery-Asperg Depression Scale (MADRS). Additional testing was performed using self-rating questionnaires concerning depression, anxiety and quality of life (QoL). Exercise capacity (VO2max) was assessed by symptom limited exercise testing. Results Of N = 33 patients diagnosed with depression at t0, N = 18 patients remitted and N = 15 were non-remitters. Remitters displayed significantly decreased anxiety (P = 0.013), improved global QoL (P = 0.002), and preserved VO2max (P = 0.958) at t1 compared to t0. This was associated with favourable health behaviour at t1 and stable body-mass-index. Contrarily, non-remitters reported further increased anxiety (P = 0.021) and no significant improvement in QoL (P = 0.405). VO2max declined significantly (P = 0.006) and body-mass-index increased (P = 0.004). Never-depressed patients showed no significant changes in anxiety (P = 0.415) or QoL (P = 0.211). VO2max decreased significantly (P < 0.001). Conclusion In ACHD, remission from depression is associated with better physical functioning, mental health, and QoL. The assessment and treatment of depression in ACHD emerges as an important clinical goal that should be included in a comprehensive multimodal treatment plan.
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Affiliation(s)
- Brit Fillies
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Lars H. Lemke
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Mhd D, A H, P N, D Y, P B. Cardiopulmonary Exercise Testing in Children and Adolescents with Repaired Tetralogy of Fallot: Mechanisms of Exercise Intolerance and Clinical Implications. Pediatr Cardiol 2024:10.1007/s00246-024-03524-7. [PMID: 38940827 DOI: 10.1007/s00246-024-03524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/12/2024] [Indexed: 06/29/2024]
Abstract
By comparison with adults, cardiopulmonary exercise testing in children with Tetralogy of Fallot is limited, and its clinical application less clarified. This study provides a comprehensive CPET profile in a child-adolescent population with repaired TOF, explores mechanisms underpinning exercise intolerance and associations with clinical outcome. Seventy-four CPETs were completed in 58 child-adolescents with rTOF (age 13.8 SD 2.4 years). CPET parameters were corrected for age, sex and body size. At follow-up (4.9 years, IQR 3.5-7.9) clinical status and re-intervention was evaluated and CPET indices predicting these outcomes determined. Cohort peak V̇O2 was within low-normal limits (% pred: 74.1% SD 15.4) with 15 patients (26%) displaying moderately severe reduction in V̇O2peak (< 65% pred). Oxygen uptake efficiency slope highly correlated with V̇O2peak (r = 0.94, p < 0.001) and was insensitive to exercise intensity. No significant change in CPET occurred in patients who underwent interval testing at 24 SD 14.5 months, although there was a variable response in V̇O2peak between individuals. Chronotropic response, lung vital capacity, heart rate-V̇O2 slope (indicator of stroke volume) predicted oxygen consumption: V̇O2peak (R2 = 50.91%, p < 0.001) and workload (R2 = 58.39%, p < 0.001). Adverse clinical status was associated with reduced workload (OR 0.97, p = 0.011). V̇E/V̇CO2 slope was steeper in those that died ((%pred:137.8 SD 60.5 vs. 108.4 SD 17.0, p < 0.019). RVOT reintervention post-CPET (24 patients, 43.8%) was associated with an increased gradient of HR-VO2 slope (OR 1.042, p = 0.004). In child-adolescents with TOF important reductions in cardiopulmonary functioning were apparent in 25% of patients. Exercise intolerance was related to reduced vital capacity, impaired chronotropic response and deficient stroke volume increment.
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Affiliation(s)
- Danton Mhd
- Department of Scottish, Pediatric Congenital Cardiac Services Royal Hospital for Children, Glasgow, G51 4TF, Scotland, UK.
- School of Cardiovascular and Metabolic, Health University of Glasgow, Glasgow, Scotland, UK.
| | - Hadjisoteriou A
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK
| | - Noonan P
- Department of Scottish, Pediatric Congenital Cardiac Services Royal Hospital for Children, Glasgow, G51 4TF, Scotland, UK
| | - Young D
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
| | - Burns P
- Department Cardiopulmonary Physiology Royal Hospital for Children, Glasgow, Scotland, UK
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Bonikowske AR, Taylor JL, Larson KF, Hardwick J, Ozemek C, Harber MP, Kaminsky LA, Arena R, Lavie CJ. Evaluating current assessment techniques of cardiorespiratory fitness. Expert Rev Cardiovasc Ther 2024; 22:231-241. [PMID: 38855917 DOI: 10.1080/14779072.2024.2363393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Considerable and convincing global data from cohorts across the health spectrum (i.e. apparently healthy to known disease) indicate that cardiorespiratory fitness (CRF) is a major predictor of overall and cardiovascular disease (CVD)-survival, seemingly with greater prognostic resolution compared to other traditional CVD risk factors. Therefore, the assessment of CRF in research and clinical settings is of major importance. AREAS COVERED In this manuscript, we review the technology of measuring CRF assessed by the 'gold standard,' cardiopulmonary exercise testing (CPET), as well as with various other methods (e.g. estimated metabolic equivalents, 6-minute walk tests, shuttle tests, and non-exercise equations that estimate CRF), all of which provide significant prognostic information for CVD- and all-cause survival. The literature through May 2024 has been cited. EXPERT OPINION The promotion of physical activity in efforts to improve levels of CRF is needed throughout the world to improve lifespan and, more importantly, healthspan. The routine assessment of CRF should be considered a vital sign that is routinely assessed in clinical practice.
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Affiliation(s)
| | - Jenna L Taylor
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn F Larson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joel Hardwick
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Matthew P Harber
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA
| | - Lenny A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA, USA
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Leonardi B, Sollazzo F, Gentili F, Bianco M, Pomiato E, Kikina SS, Wald RM, Palmieri V, Secinaro A, Calcagni G, Butera G, Giordano U, Cafiero G, Drago F. Cardiopulmonary Exercise Testing after Surgical Repair of Tetralogy of Fallot-Does Modality Matter? J Clin Med 2024; 13:1192. [PMID: 38592039 PMCID: PMC10932302 DOI: 10.3390/jcm13051192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite a successful repair of tetralogy of Fallot (rToF) in childhood, residual lesions are common and can contribute to impaired exercise capacity. Although both cycle ergometer and treadmill protocols are often used interchangeably these approaches have not been directly compared. In this study we examined cardiopulmonary exercise test (CPET) measurements in rToF. METHODS Inclusion criteria were clinically stable rToF patients able to perform a cardiac magnetic resonance imaging (CMR) and two CPET studies, one on the treadmill (incremental Bruce protocol) and one on the cycle ergometer (ramped protocol), within 12 months. Demographic, surgical and clinical data; functional class; QRS duration; CMR measures; CPET data and international physical activity questionnaire (IPAQ) scores of patients were collected. RESULTS Fifty-seven patients were enrolled (53% male, 20.5 ± 7.8 years at CPET). CMR measurements included a right ventricle (RV) end-diastolic volume index of 119 ± 22 mL/m2, a RV ejection fraction (EF) of 55 ± 6% and a left ventricular (LV) EF of 56 ± 5%. Peak oxygen consumption (VO2)/Kg (25.5 ± 5.5 vs. 31.7 ± 6.9; p < 0.0001), VO2 at anaerobic threshold (AT) (15.3 ± 3.9 vs. 22.0 ± 4.5; p < 0.0001), peak O2 pulse (10.6 ± 3.0 vs. 12.1± 3.4; p = 0.0061) and oxygen uptake efficiency slope (OUES) (1932.2 ± 623.6 vs. 2292.0 ± 639.4; p < 0.001) were significantly lower on the cycle ergometer compared with the treadmill, differently from ventilatory efficiency (VE/VCO2) max which was significantly higher on the cycle ergometer (32.2 ± 4.5 vs. 30.4 ± 5.4; p < 0.001). Only the VE/VCO2 slope at the respiratory compensation point (RCP) was similar between the two methodologies (p = 0.150). CONCLUSIONS The majority of CPET measurements differed according to the modality of testing, with the exception being the VE/VCO2 slope at RCP. Our data suggest that CPET parameters should be interpreted according to test type; however, these findings should be validated in larger populations and in a variety of institutions.
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Affiliation(s)
- Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.P.); (G.C.); (G.B.); (F.D.)
| | - Fabrizio Sollazzo
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.B.); (V.P.)
| | - Federica Gentili
- Unit of Sport Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.G.); (U.G.); (G.C.)
| | - Massimiliano Bianco
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.B.); (V.P.)
| | - Elettra Pomiato
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.P.); (G.C.); (G.B.); (F.D.)
| | - Stefani Silva Kikina
- Department of General Surgery, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Westcliff-on-Sea SS0 0RY, UK;
| | - Rachel Maya Wald
- Toronto General Hospital Research Institute (TGHRI), Toronto, ON M5G 2N2, Canada;
| | - Vincenzo Palmieri
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.B.); (V.P.)
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy;
| | - Giulio Calcagni
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.P.); (G.C.); (G.B.); (F.D.)
| | - Gianfranco Butera
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.P.); (G.C.); (G.B.); (F.D.)
| | - Ugo Giordano
- Unit of Sport Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.G.); (U.G.); (G.C.)
| | - Giulia Cafiero
- Unit of Sport Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.G.); (U.G.); (G.C.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.P.); (G.C.); (G.B.); (F.D.)
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Edelson JB, Zak V, Goldberg D, Fleming G, Mackie AS, Patel JK, Files M, Downing T, Richmond M, Acheampong B, Cartoski M, Detterich J, McCrindle B, McHugh K, Hansen JE, Wagner J, Maria MD, Weingarten A, Nowlen T, Yoon JK, Kim GB, Williams R, Whitehill R, Kirkpatrick E, Yin S, Ermis P, Lubert AM, Stylianou M, Freemon D, Hu C, Garuba OD, Frommelt P, Goldstein BH, Paridon S, Garg R. The Effect of Udenafil on Heart Rate and Blood Pressure in Adolescents With the Fontan Circulation. Am J Cardiol 2024; 210:183-187. [PMID: 37918818 PMCID: PMC10872492 DOI: 10.1016/j.amjcard.2023.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 11/04/2023]
Abstract
The Fontan Udenafil Exercise Longitudinal (FUEL) trial showed that treatment with udenafil was associated with improved exercise performance at the ventilatory anaerobic threshold in children with Fontan physiology. However, it is not known how the initiation of phosphodiesterase 5 inhibitor therapy affects heart rate and blood pressure in this population. These data may help inform patient selection and monitoring after the initiation of udenafil therapy. The purpose of this study is to evaluate the effects of udenafil on vital signs in the cohort of patients enrolled in the FUEL trial. This international, multicenter, randomized, double-blind, placebo-controlled trial of udenafil included adolescents with single ventricle congenital heart disease who had undergone Fontan palliation. Changes in vital signs (heart rate [HR], systolic [SBP] and diastolic blood pressure [DBP]) were compared both to subject baseline and between the treatment and the placebo groups. Additional exploratory analyses were performed to evaluate changes in vital signs for prespecified subpopulations believed to be most sensitive to udenafil initiation. Baseline characteristics were similar between the treatment and placebo cohorts (n = 200 for each). The groups demonstrated a decrease in HR, SBP, and DBP 2 hours after drug/placebo administration, except SBP in the placebo group. There was an increase in SBP from baseline to after 6-min walk test in the treatment and placebo groups, and the treatment group showed an increase in HR (87.4 ± 15.0 to 93.1 ± 19.4 beats/min, p <0.01) after exercise. When comparing changes from baseline to the 26-week study visit, small decreases in both SBP (-1.9 ± 12.3 mm Hg, p = 0.03) and DBP (-3.0 ± 9.6 mm Hg, p <0.01) were seen in the treatment group. There were no clinically significant differences between treatment and placebo group in change in HR or blood pressure in the youngest age quartile, lightest weight quartile, or those on afterload-reducing agents. In conclusion, initiation of treatment with udenafil in patients with Fontan circulation was not associated with clinically significant changes in vital signs, implying that for patients similar to those enrolled in the FUEL trial, udenafil can be started without the requirement for additional monitoring after initial administration.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania.
| | | | - David Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Greg Fleming
- Duke Children's Pediatric and Congenital Heart Center, Durham, North Carolina
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, California
| | - Jyoti K Patel
- Division of Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew Files
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Tacy Downing
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia
| | - Marc Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Ben Acheampong
- Children's Hospital and Medical Center, University of Nebraska, Omaha, Nebraska
| | - Mark Cartoski
- Nemours Cardiac Center, Nemours / Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Brian McCrindle
- Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Kimberly McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Jesse E Hansen
- Division of Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Wagner
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, Missouri; Division of Clinical Pharmacology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Michael Di Maria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Angela Weingarten
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Nowlen
- Heart Center, Phoenix Children's Hospital, Phoenix, Arizona
| | - Ja Kyoung Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Gi Beom Kim
- Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Richard Williams
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Robert Whitehill
- Emory University, School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Edward Kirkpatrick
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Suellen Yin
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Peter Ermis
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Adam M Lubert
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mario Stylianou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood, Institute, National Institutes of Health, Bethesda, Maryland
| | - D'Andrea Freemon
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood, Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Olukayode D Garuba
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Peter Frommelt
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Bryan H Goldstein
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ruchira Garg
- Departments of Cardiology and Pediatrics, Cedars-Sinai Guerin Children's and Smidt Heart Institute, Los Angeles, California
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7
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Goldberg DJ, Hu C, Lubert AM, Rathod RH, Penny DJ, Petit CJ, Schumacher KR, Ginde S, Williams RV, Yoon JK, Kim GB, Nowlen TT, DiMaria MV, Frischhertz BP, Wagner JB, McHugh KE, McCrindle BW, Cartoski MJ, Detterich JA, Yetman AT, John AS, Richmond ME, Yung D, Payne RM, Mackie AS, Davis CK, Shahanavaz S, Hill KD, Almaguer M, Zak V, McBride MG, Goldstein BH, Pearson GD, Paridon SM. The Fontan Udenafil Exercise Longitudinal Trial: Subgroup Analysis. Pediatr Cardiol 2023; 44:1691-1701. [PMID: 37382636 DOI: 10.1007/s00246-023-03204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023]
Abstract
The Pediatric Heart Network's Fontan Udenafil Exercise Longitudinal (FUEL) Trial (Mezzion Pharma Co. Ltd., NCT02741115) demonstrated improvements in some measures of exercise capacity and in the myocardial performance index following 6 months of treatment with udenafil (87.5 mg twice daily). In this post hoc analysis, we evaluate whether subgroups within the population experienced a differential effect on exercise performance in response to treatment. The effect of udenafil on exercise was evaluated within subgroups defined by baseline characteristics, including peak oxygen consumption (VO2), serum brain-type natriuretic peptide level, weight, race, gender, and ventricular morphology. Differences among subgroups were evaluated using ANCOVA modeling with fixed factors for treatment arm and subgroup and the interaction between treatment arm and subgroup. Within-subgroup analyses demonstrated trends toward quantitative improvements in peak VO2, work rate at the ventilatory anaerobic threshold (VAT), VO2 at VAT, and ventilatory efficiency (VE/VCO2) for those randomized to udenafil compared to placebo in nearly all subgroups. There was no identified differential response to udenafil based on baseline peak VO2, baseline BNP level, weight, race and ethnicity, gender, or ventricular morphology, although participants in the lowest tertile of baseline peak VO2 trended toward larger improvements. The absence of a differential response across subgroups in response to treatment with udenafil suggests that the treatment benefit may not be restricted to specific sub-populations. Further work is warranted to confirm the potential benefit of udenafil and to evaluate the long-term tolerability and safety of treatment and to determine the impact of udenafil on the development of other morbidities related to the Fontan circulation.Trial Registration NCT0274115.
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Affiliation(s)
- David J Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | | | - Adam M Lubert
- Cincinnati Children's Hospital and Medical Center, Heart Institute, Cincinnati, OH, 45229, USA
| | - Rahul H Rathod
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Daniel J Penny
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA
| | - Kurt R Schumacher
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Salil Ginde
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, 53226, USA
| | - Richard V Williams
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, 84132, USA
| | - J K Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Gi Beom Kim
- Seoul National University School of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Todd T Nowlen
- Heart Center, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Michael V DiMaria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Benjamin P Frischhertz
- Division of Cardiology, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Jonathan B Wagner
- Divisions of Cardiology and Clinical Pharmacology, Children's Mercy Kansas City, Kansas City, MO, 64108, USA
| | - Kimberly E McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Brian W McCrindle
- Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Mark J Cartoski
- Nemours Cardiac Center, Nemours / Alfred I. DuPont Hospital for Children, Wilmington, DE, 19803, USA
| | - Jon A Detterich
- Division of Cardiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, 90027, USA
| | - Anji T Yetman
- Children's Hospital and Medical Center, University of Nebraska, Omaha, NE, 68114, USA
| | - Anitha S John
- Division of Cardiology, Children's National Hospital, Washington, DC, 20010, USA
| | - Marc E Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA
| | - Delphine Yung
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - R Mark Payne
- Division of Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
| | - Christopher K Davis
- Division of Cardiology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, 92123, USA
| | - Shabana Shahanavaz
- Division of Cardiology, St. Louis Children's Hospital, St. Louis, MO, 63110, USA
| | - Kevin D Hill
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC, 27705, USA
| | - Marisa Almaguer
- Cincinnati Children's Hospital and Medical Center, Heart Institute, Cincinnati, OH, 45229, USA
| | | | - Michael G McBride
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Bryan H Goldstein
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224, USA
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, 20892, USA
| | - Stephen M Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
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Leonardi B, Cifra B. The Role of Cardiopulmonary Testing to Risk Stratify Tetralogy of Fallot Patients. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:314-321. [PMID: 38161674 PMCID: PMC10755826 DOI: 10.1016/j.cjcpc.2023.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024]
Abstract
Neonatal repair has completely changed the clinical history of patients with tetralogy of Fallot (ToF); however, these patients carry a significant risk of severe arrhythmias and sudden cardiac death in the long term. The exact mechanism for late sudden cardiac death is multifactorial and still not well defined, and the risk stratification for primary prophylaxis in these patients remains challenging. Cardiopulmonary exercise testing (CPET) is a well-established and safe method to assess cardiopulmonary function in children and adults with congenital heart disease. Several parameters obtained with CPET have been identified as potential prognostic of major adverse cardiovascular events in congenital heart disease. CPET is routinely used to assess functional capacity also in patients with ToF, and there is some evidence showing its usefulness in predicting the cardiac adverse events in patients with repaired ToF. Current guidelines recognize the importance of CPET in the evaluation and management of patients with ToF, but there is no clear consensus on which the CPET parameter or level of exercise intolerance, as measured by CPET, is truly predictive of an increased risk of arrhythmia and major adverse cardiovascular events in this population. Therefore, the aim of this narrative review is to describe the current evidence on the potential use of CPET in the risk stratification of patients with repaired ToF.
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Affiliation(s)
- Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Hospital, IRCCS, Rome, Italy
| | - Barbara Cifra
- Division of Cardiology, Labatt Family Heart Centre, the Hospital for Sick Children, Toronto, Ontario, Canada
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9
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Buchanan M, Spence C, Keir M, Khoury M. Physical Activity Promotion Among Individuals With Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:322-334. [PMID: 38161681 PMCID: PMC10755793 DOI: 10.1016/j.cjcpc.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 01/03/2024]
Abstract
In the general population, the most cited barriers to physical activity (PA) are time, energy, and motivation. Consequently, despite the significant contribution of PA to health and well-being, many individuals are insufficiently active. Physical inactivity and sedentary lifestyles increase the risk of acquired cardiometabolic disease, a risk that may complicate and is compounded by the anatomic and physiologic features inherent in the patient with repaired tetralogy of Fallot (ToF). Individuals with ToF commonly present with reduced exercise capacity and PA levels. In light of historically PA restrictive management of their heart disease, known reductions in exercise capacity among individuals with ToF are combined with psychosocial barriers to their participation, potentially establishing a cycle of further detraining, inactivity, and disease progression/health decline. To this end, children and young adults with ToF are known to have reduced self-efficacy towards PA, defined as their confidence in their ability to participate. In this review, we apply self-efficacy as an overarching mediator of PA participation and explore trends and determinants of PA participation among individuals with ToF and its subsequent impact on exercise capacity, disease risk, and health-related quality of life. We outline the rationale and strategies aimed at improving PA in children and adults with ToF and highlight current knowledge gaps and future directions in the promotion of PA in the population with ToF.
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Affiliation(s)
- Mackenzie Buchanan
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Spence
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Keir
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Moscatelli S, Pergola V, Motta R, Fortuni F, Borrelli N, Sabatino J, Leo I, Avesani M, Montanaro C, Surkova E, Mapelli M, Perrone MA, di Salvo G. Multimodality Imaging Assessment of Tetralogy of Fallot: From Diagnosis to Long-Term Follow-Up. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1747. [PMID: 38002838 PMCID: PMC10670209 DOI: 10.3390/children10111747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common complex congenital heart disease with long-term survivors, demanding serial monitoring of the possible complications that can be encountered from the diagnosis to long-term follow-up. Cardiovascular imaging is key in the diagnosis and serial assessment of TOF patients, guiding patients' management and providing prognostic information. Thorough knowledge of the pathophysiology and expected sequalae in TOF, as well as the advantages and limitations of different non-invasive imaging modalities that can be used for diagnosis and follow-up, is the key to ensuring optimal management of patients with TOF. The aim of this manuscript is to provide a comprehensive overview of the role of each modality and common protocols used in clinical practice in the assessment of TOF patients.
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Affiliation(s)
- Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Valeria Pergola
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità pubblica, University Hospital of Padua, 35128 Padua, Italy
| | - Raffaella Motta
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità pubblica, University Hospital of Padua, 35128 Padua, Italy
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
- Department of Cardiology, Leiden University Medical Center, 2300 Leiden, The Netherlands
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Jolanda Sabatino
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Isabella Leo
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women and Children's Health, University Hospital of Padua, 35128 Padua, Italy
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas's NHS Foundation Trust, London SW3 5NP, UK
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Elena Surkova
- Department of Echocardiography, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Marco Alfonso Perrone
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
- Division of Cardiology and Cardio Lab, Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giovanni di Salvo
- Division of Paediatric Cardiology, Department of Women and Children's Health, University Hospital of Padua, 35128 Padua, Italy
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Stäbler T, Weigelt A, Rottermann K, Wällisch W, Hübner M, Dittrich S, Schöffl I. COPHYD (Corona Owed Physical Deficiency): The Impact of Lockdown on Cardiopulmonary Function in Paediatric Cardiology Patients. KLINISCHE PADIATRIE 2023; 235:290-296. [PMID: 36174587 DOI: 10.1055/a-1906-1187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Due to the Corona-lockdowns the closure of sports facilities and schools has led to a decline in physical activity (PA) for months. PA is essential for maintaining cardiopulmonary function assessed by peak oxygen uptake. Since peak oxygen uptake represents the best predictor for mortality and morbidity in children with congenital heart disease the impact of lockdowns on this parameter is vital. METHODS We evaluated retrospectively cardiopulmonary exercise data from our patient collective from before lockdown with twin-paired data from during lockdown. The twin-pairing was achieved by matching patients with similar heart disease, age, sex, and test method. Cardiopulmonary exercise testing was achieved on either the treadmill or the bicycle. RESULTS We were able to twin-pair 90 cases (26 twins with heart disease and 19 healthy twins). There was a significant decrease of cardiopulmonary function (V̇O2peak: 35.7±9.8 vs.30.4±10.6) in the heart disease cohort along with a significant decrease in peak oxygen pulse (13.3±4.1 vs. 11.4±4.5), and peak minute ventilation (V ̇E: 83.05±29.08 vs.71,49±24.96). The healthy children improved over the timeframe, but this only reached significance for peak minute ventilation (81.72±25.79 vs.97.94±31.4). CONCLUSION We observed a significant decline of peak oxygen uptake during lockdown in the group of congenital heart disease (CHD) patients. This involved a loss of cardiac function as well as pulmonary function. This could be explained by limited access to sports facilities and restriction of regular daily movement due to school closure and overprotection. Healthy children improved their pulmonary function. This might be an indication of an improvement of exercise during confinement.Aufgrund des Corona-Lockdowns hat die Schließung von Sportanlagen und Schulen über Monate zu einem Rückgang der körperlichen Aktivität geführt. Körperliche Aktivität ist für die Aufrechterhaltung der kardiopulmonalen Funktion, bewertet durch die maximale Sauerstoffaufnahme, unerlässlich. Da die maximale Sauerstoffaufnahme der beste Prädiktor für Mortalität und Morbidität bei Kindern mit angeborenen Herzerkrankungen ist, sind die Auswirkungen des Lockdowns auf diesen Parameter von entscheidender Bedeutung. Spiroergometriedaten unseres Patientenkollektivs aus der Zeit vor dem Lockdown wurde mit Daten von statistischen Zwillingen aus dem gleichen Kollektiv während des Lockdowns verglichen. Die Zwillingspaarung wurde erreicht, indem Patienten mit ähnlichen Herzerkrankungen, Alter, Geschlecht und Testmodalitäten verglichen wurden. Die Spiroergometrie wurde entweder auf dem Laufband oder auf dem Fahrrad durchgeführt. Insgesamt wurden 90 Datensätze verbunden (26 Zwillinge mit Herzkrankheit und 19 gesunde Zwillinge). In der Kohorte der Herzerkrankten konnte eine signifikante Verschlechterung der kardiopulmonalen Funktion (V̇O2peak: 35,7±9,8 vs. 30,4±10,6), des Spitzensauerstoffpulses (O2puls: 13,3±4,1 vs. 11,4±4,5) und der Spitzenminutenventilation (VE: 83,05 ± 29,08 vs. 71,49 ± 24,96) beobachtet werden. Die gesunden Kinder verbesserten sich im Laufe der Zeit, wobei der Anstieg nur bei der Spitzenminutenventilation (81,72±25,79 vs. 97,94 ± 31,4) signifikant war. in der Kohorte der Patienten mit angeborenen Herzerkrankungen (CHD) beobachteten wir einen deutlichen Rückgang der maximalen Sauerstoffaufnahme während des Lockdowns. Dies liegt begründet in einer Verschlechterung der Herz-, sowie der Lungenfunktion. Erklärung dafür könnte der begrenzte Zugang zu Sporteinrichtungen, sowie Einschränkungen der täglichen Bewegungsfreiheit durch Schulschließungen und Überbehütung sein. Gesunde Kinder konnten ihr Atemminutenvolumen während dem Lockdown steigern und zeigten einen Trend zu besserer Belastbarkeit. Dies könnte auf eine Zunahme der körperlichen Bewegung während des Lockdowns hindeuten.
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Affiliation(s)
- Tim Stäbler
- Department of Paediatric Cardiology, FAU, Erlangen, Germany
| | - Annika Weigelt
- Pediatric Cardiology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | | | | | | | - Sven Dittrich
- Pediatric Cardiology, University Hospital, Erlangen, Germany
| | - Isabelle Schöffl
- Kinderkardiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg Medizinische Fakultät, Erlangen, Germany
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12
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Villaseca-Rojas Y, Varela-Melo J, Torres-Castro R, Vasconcello-Castillo L, Mazzucco G, Vilaró J, Blanco I. Exercise Capacity in Children and Adolescents With Congenital Heart Disease: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:874700. [PMID: 35600470 PMCID: PMC9114479 DOI: 10.3389/fcvm.2022.874700] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Congenital heart disease (CHD) entails structural defects in the morphogenesis of the heart or its main vessels. Analyzing exercise capacity of children and adolescents with CHD is important to improve their functional condition and quality of life, since it can allow timely intervention on poor prognostic factors associated with higher risk of morbidity and mortality. Objective To describe exercise capacity in children and adolescents with CHD compared with healthy controls. Methods A systematic review was carried out. Randomized clinical trials and observational studies were included assessing exercise capacity through direct and indirect methods in children and adolescents between 5 and 17 years-old. A sensitive analysis was performed including studies with CHD repaired participants. Additionally, it was sub-analyzed by age range (< and ≥ 12 years old). Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence. Results 5619 articles were found and 21 were considered for the review. Eighteen articles used the direct exercise capacity measurement method by cardiopulmonary exercise test (CPET). The CHD group showed significant differences in peak oxygen consumption (VO2peak) with a value of −7.9 ml/Kg/min (95% CI: −9.9, −5.9, p = 0.00001), maximum workload (Wmax) −41.5 (95% CI: −57.9, −25.1 watts, p = 0.00001), ventilatory equivalent (VE/VCO2) slope 2.6 (95% CI: 0.3, 4.8), oxygen pulse (O2 pulse)−2.4 ml/beat (95% CI: −3.7, −1.1, p = 0.0003), and maximum heart rate (HRmax) −15 bpm (95% CI: −18, −12 bpm, p = 0.00001), compared with healthy controls. Adolescents (≥ 12 yrs) with CHD had a greater reduction in VO2peak (−10.0 ml/Kg/min (95% CI: −12.0, −5.3), p < 0.00001), Wmax (−45.5 watts (95% CI: −54.4, −36.7), p < 0.00001) and HRmax (−21 bpm (95% CI: −28, −14), p<0.00001). Conclusion Suffering CHD in childhood and adolescence is associated with lower exercise capacity as shown by worse VO2peak, Wmax, VE/VCO2 slope, O2 pulse, and HRmax compared with matched healthy controls. The reduction in exercise capacity was greater in adolescents. Systematic Review Registration www.crd.york.ac.uk/prospero/display_record.php?RecordID=208963, identifier: CRD42020208963.
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Affiliation(s)
- Yenny Villaseca-Rojas
- Programa de Magíster en Fisiología Clínica del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
- Servicio de Kinesiología, Unidad de Medicina Física y Rehabilitación, Hospital Clínico UC-CHRISTUS, Santiago, Chile
| | - Javiera Varela-Melo
- Programa de Magíster en Fisiología Clínica del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
- Servicio de Kinesiología, Unidad de Medicina Física y Rehabilitación, Hospital Clínico UC-CHRISTUS, Santiago, Chile
- *Correspondence: Javiera Varela-Melo
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis Vasconcello-Castillo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Guillermo Mazzucco
- Instituto Cardiovascular de Rosario, Rosario, Argentina
- Universidad del Gran Rosario, Rosario, Argentina
| | - Jordi Vilaró
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
- Blanquerna School of Health Sciences, Global Research on Wellbeing (GRoW), Universitat Ramon Llull, Barcelona, Spain
| | - Isabel Blanco
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
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14
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Associations between blood biomarkers, cardiac function and adverse outcome in a young tetralogy of Fallot cohort. Int J Cardiol 2022; 361:31-37. [PMID: 35487320 DOI: 10.1016/j.ijcard.2022.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND To determine the potential prognostic value and clinical correlations of blood biomarkers in a cohort of patients with Tetralogy of Fallot (TOF). METHODS In the setting of multicenter prospective research studies TOF patients underwent blood sampling, cardiopulmonary exercise testing and low-dose dobutamine stress cardiac magnetic resonance (CMR) imaging. In the blood sample NT-proBNP, GDF-15, Galectin-3, ST-2, DLK-1, FABP4, IGFBP-1, IGFBP-7, MMP-2, and vWF were assessed. During subsequent follow-up, patients were evaluated for reaching the study endpoint (cardiac death, arrhythmia-related hospitalization or cardioversion/ablation, VO2 max ≤65% of predicted). Regression analysis was used to explore the correlation between blood biomarkers (corrected for age and gender) and other clinical parameters. The potential predictive value of blood biomarkers and events were assessed with Kaplan-Meier analysis and Cox proportional hazard analysis. RESULTS We included 137 Fallot patients, median age 19.2 (interquartile range: 14.6-25.7) years, median age at TOF-repair 0.9 (0.5-1.9) years. After a median follow-up of 8.7 (6.3-10.7) years, 20 (14.6%) patients reached the composite endpoint. In a multivariable cox-regression analysis corrected for age at study baseline, elevated IGFBP-7 and MMP-2 levels were associated with the composite endpoint. We also noted a correlation between DLK-1 and relative change in right ventricular end systolic volume during dobutamine stress CMR (β = -0.27, p = 0.010), a correlation between FABP4 and Max VO2 (β = -0.41, p ≤0.001 and between MMP-2 and tricuspid valve E/A ratio (β = -0.15, p = 0.037). CONCLUSIONS IGFBP-7, MMP-2 and DLK-1 levels are related to cardiac function and long-term outcome in TOF patients.
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15
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Novaković M, Prokšelj K, Jug B. Exercise capacity, cardiac and endothelial function in adults with repaired tetralogy of Fallot. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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16
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Cardiopulmonary Exercise Testing in Repaired Tetralogy of Fallot: Multiparametric Overview and Correlation with Cardiac Magnetic Resonance and Physical Activity Level. J Cardiovasc Dev Dis 2022; 9:jcdd9010026. [PMID: 35050237 PMCID: PMC8778451 DOI: 10.3390/jcdd9010026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with repaired Tetralogy of Fallot (rToF) typically report having preserved subjective exercise tolerance. Chronic pulmonary regurgitation (PR) with varying degrees of right ventricular (RV) dilation as assessed by cardiac magnetic resonance imaging (MRI) is prevalent in rToF and may contribute to clinical compromise. Cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capacity, and the International Physical Activity Questionnaire (IPAQ) can provide additional data on physical activity (PA) achieved. Our aim was to assess the association between CPET values, IPAQ measures, and MRI parameters. All rToF patients who had both an MRI and CPET performed within one year between March 2019 and June 2021 were selected. Clinical data were extracted from electronic records (including demographic, surgical history, New York Heart Association (NYHA) functional class, QRS duration, arrhythmia, MRI parameters, and CPET data). PA level, based on the IPAQ, was assessed at the time of CPET. Eighty-four patients (22.8 ± 8.4 years) showed a reduction in exercise capacity (median peak VO2 30 mL/kg/min (range 25–33); median percent predicted peak VO2 68% (range 61–78)). Peak VO2, correlated with biventricular stroke volumes (RVSV: β = 6.11 (95%CI, 2.38 to 9.85), p = 0.002; LVSV: β = 15.69 (95% CI 10.16 to 21.21), p < 0.0001) and LVEDVi (β = 8.74 (95%CI, 0.66 to 16.83), p = 0.04) on multivariate analysis adjusted for age, gender, and PA level. Other parameters which correlated with stroke volumes included oxygen uptake efficiency slope (OUES) (RVSV: β = 6.88 (95%CI, 1.93 to 11.84), p = 0.008; LVSV: β = 17.86 (95% CI 10.31 to 25.42), p < 0.0001) and peak O2 pulse (RVSV: β = 0.03 (95%CI, 0.01 to 0.05), p = 0.007; LVSV: β = 0.08 (95% CI 0.05 to 0.11), p < 0.0001). On multivariate analysis adjusted for age and gender, PA level correlated significantly with peak VO2/kg (β = 0.02, 95% CI 0.003 to 0.04; p = 0.019). We observed a reduction in objective exercise tolerance in rToF patients. Biventricular stroke volumes and LVEDVi were associated with peak VO2 irrespective of RV size. OUES and peak O2 pulse were also associated with biventricular stroke volumes. While PA level was associated with peak VO2, the incremental value of this parameter should be the focus of future studies.
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Masood IR, Detterich J, Cerrone D, Lewinter K, Shah P, Kato R, Sabati A. Reduced Forced Vital Capacity and the Number of Chest Wall Surgeries are Associated with Decreased Exercise Capacity in Children with Congenital Heart Disease. Pediatr Cardiol 2022; 43:54-61. [PMID: 34365518 DOI: 10.1007/s00246-021-02692-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Low forced vital capacity (FVC) is associated with decreased exercise capacity in CHD. Multiple prior cardiac surgeries have been associated with low FVC. We seek to understand the relationship between low FVC, number of cardiac surgeries and cardiopulmonary response leading to decreased exercise capacity. Retrospective chart review of demographics, surgical history and exercise testing including spirometry was performed in patients with CHD. Single ventricle patients were excluded. Low FVC was defined as a Z-score below the lower limit of normal. Exercise parameters were expressed as a percent of predicted. There were 93 patients with 2 ventricle CHD identified over 34 months with cardiopulmonary exercise testing. The FVC Z-score directly correlated with peak V̇O2% (R2 = 0.07, p < 0.05), and the O2 pulse% (R2 = 0.25, p < 0.0001). The VE/VCO2 was inversely related to the FVC Z-score (R2 = 0.11, p < 0.01). Patients with minimum three prior surgeries had decreased peak VO2% (63.7 vs. 72.8, p < 0.05), decreased peak O2 pulse% (80.8 vs. 97.9, p < 0.01) and a lower mean FVC Z-score (- 1.9 vs - 0.38, p < 0.01). The FVC Z-score and number of surgeries both predicted peak V̇O2% in multivariate analysis. Our study demonstrated that low FVC and three or more prior cardiac surgeries were associated with lower exercise capacity and lower stroke volume response. More cardiac surgeries were also associated with low FVC. However, both low FVC and the number of surgeries were independent predictors of exercise capacity.
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Affiliation(s)
- Imran R Masood
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA.
| | - Jon Detterich
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
| | - Daniel Cerrone
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
| | - Katherine Lewinter
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
| | - Payal Shah
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
| | - Roberta Kato
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
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18
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Chang YL, Kuan TH, Chen CH, Tsai YJ, Chen GB, Lin KL, Tuan SH. Differences in Cardiopulmonary Fitness Between Boy and Girls With Repaired Tetralogy of Fallot. Front Pediatr 2022; 10:911825. [PMID: 35874578 PMCID: PMC9298839 DOI: 10.3389/fped.2022.911825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Many studies have demonstrated that patients with repaired tetralogy of Fallot (rTOF) have generally poorer cardiopulmonary fitness (CPF). However, little is known about how the disease results in different CPF in each sex. Therefore, this study aimed to investigate whether sex (and gender) differences affect CPF in children and adolescents with rTOF. METHODS This retrospective study recruited adolescents and children (aged 10-18) with rTOF following an acute stage of tetralogy of Fallot (TOF) who received cardiopulmonary exercise testing (CPET) in the past 10 years. CPF was determined by symptom-limited CPET with a treadmill under ramped Bruce protocol. Boys and girls were categorized into groups based on body mass index (BMI) and fat mass index (FMI). The BMI was grouped by Taiwanese obesity cutoff points. The FMI was categorized by the body fat percentage. Excess adiposity was defined as (1) "overweight" and "obese" by BMI and (2) greater than the sex- and age-specific 75th percentile of whole subjects by FMI. RESULTS A total of 185 participants (104 boys and 81 girls) with rTOF were recruited for the final analysis. Within the BMI category, 76 boys and 63 girls were in the normal group, whereas 28 boys and 18 girls were in the excessive adiposity group. Within the FMI category, 77 boys and 60 girls were in the normal group, whereas 27 boys and 21 girls were in the excessive adiposity group. The analysis of the body composition of rTOF subjects showed that there was no statistically significant difference between the subgroups of the two sexes, but both showed a smaller body size than normal Taiwanese children. When comparing the CPF within different BMI and FMI groups, the children in the excessive adiposity group had significantly lower values in metabolic equivalents (MET) at anaerobic threshold, peak MET, and measured peak oxygen consumption (VO2) to predicted peak VO2, regardless of sex. Moreover, boys (60.90%) presented poorer CPF than girls (74.22%, p < 0.001). CONCLUSION In Taiwan, patients with rTOF had poorer CPF than healthy peers. This study found that girls with rTOF had better CPF than boys with rTOF. The effect of gender stereotypes on sports participation and self-efficacy might be one of the contributing factors; however, further investigations are warranted to determine the causal effect.
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Affiliation(s)
- Yung-Liang Chang
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tzu-Hsuan Kuan
- Department of General Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ju Tsai
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan City, Taiwan.,Department of Physical Therapy, National Cheng Kung University, Tainan City, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Ko-Long Lin
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Physical Medicine and Rehabilitation, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Sheng-Hui Tuan
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan City, Taiwan.,Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
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Ghonim S, Gatzoulis MA, Ernst S, Li W, Moon JC, Smith GC, Heng EL, Keegan J, Ho SY, McCarthy KP, Shore DF, Uebing A, Kempny A, Alpendurada F, Diller GP, Dimopoulos K, Pennell DJ, Babu-Narayan SV. Predicting Survival in Repaired Tetralogy of Fallot: A Lesion-Specific and Personalized Approach. JACC Cardiovasc Imaging 2021; 15:257-268. [PMID: 34656466 PMCID: PMC8821017 DOI: 10.1016/j.jcmg.2021.07.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022]
Abstract
Objectives This study sought to identify patients with repaired tetralogy of Fallot (rTOF) at high risk of death and malignant ventricular arrhythmia (VA). Background To date there is no robust risk stratification scheme to predict outcomes in adults with rTOF. Methods Consecutive patients were prospectively recruited for late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) to define right and left ventricular (RV, LV) fibrosis in addition to proven risk markers. Results The primary endpoint was all-cause mortality. Of the 550 patients (median age 32 years, 56% male), 27 died (mean follow-up 6.4 ± 5.8; total 3,512 years). Mortality was independently predicted by RVLGE extent, presence of LVLGE, RV ejection fraction ≤47%, LV ejection fraction ≤55%, B-type natriuretic peptide ≥127 ng/L, peak exercise oxygen uptake (V02) ≤17 mL/kg/min, prior sustained atrial arrhythmia, and age ≥50 years. The weighted scores for each of the preceding independent predictors differentiated a high-risk subgroup of patients with a 4.4%, annual risk of mortality (area under the curve [AUC]: 0.87; P < 0.001). The secondary endpoint (VA), a composite of life-threatening sustained ventricular tachycardia/resuscitated ventricular fibrillation/sudden cardiac death occurred in 29. Weighted scores that included several predictors of mortality and RV outflow tract akinetic length ≥55 mm and RV systolic pressure ≥47 mm Hg identified high-risk patients with a 3.7% annual risk of VA (AUC: 0.79; P < 0.001) RVLGE was heavily weighted in both risk scores caused by its strong relative prognostic value. Conclusions We present a score integrating multiple appropriately weighted risk factors to identify the subgroup of patients with rTOF who are at high annual risk of death who may benefit from targeted therapy.
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Affiliation(s)
- Sarah Ghonim
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Michael A Gatzoulis
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Sabine Ernst
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Wei Li
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - James C Moon
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Gillian C Smith
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Ee Ling Heng
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Jennifer Keegan
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Siew Yen Ho
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Karen P McCarthy
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Darryl F Shore
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Anselm Uebing
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Aleksander Kempny
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Francisco Alpendurada
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Gerhard P Diller
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Konstantinos Dimopoulos
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Dudley J Pennell
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Sonya V Babu-Narayan
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom.
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20
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Sandström A, Wikner A, Rinnström D, Sandberg C, Christersson C, Dellborg M, Nielsen NE, Sörensson P, Thilén U, Johansson B. Exercise capacity in adult patients with tetralogy of Fallot. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Better preoperative exercise function is associated with shorter hospital stay after paediatric pulmonary valve replacement or conduit revision. Cardiol Young 2021; 31:1636-1643. [PMID: 33658103 DOI: 10.1017/s1047951121000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Exercise capacity is a modifiable factor in patients with CHD that has been related to surgical outcomes in adults. We hypothesised that this was true for children undergoing surgical pulmonary valve replacement; therefore, the relationship of preoperative percent predicted peak oxygen consumption to surgical outcomes as measured by total hospital length of stay was explored. METHODS Single centre retrospective cohort study of patients aged 8-18 years who underwent surgical pulmonary valve replacement. The primary predictor was preoperative percent predicted peak oxygen consumption, and primary outcome was total hospital length of stay. Clinical, imaging, and cardiopulmonary exercise test data were reviewed and compared to total hospital length of stay. Cox proportional hazards regression was used to examine the association between total hospital length of stay and percent predicted peak oxygen consumption. RESULTS Three-hundred and seventy patients undergoing pulmonary valve replacement/conduit change between 2003 and 2017 at Boston Children's Hospital were identified. Ninety had preoperative cardiopulmonary exercise tests within 6 months of surgery. Exclusion for inadequate exercise data (n = 3) and imaging data (n = 1) left 86 patients for review. Patients with percent predicted peak oxygen consumption ≥ 70% (n = 46, 53%) had shorter total hospital length of stay (4.4 days) than the 40 with percent predicted peak oxygen consumption <70% (5.4 days, p = 0.007). Median percent predicted peak oxygen consumption increased over sequential surgical eras (p < 0.001), but total hospital length of stay did not correlate with surgical era, preoperative left ventricular function, or preoperative right ventricular dilation. CONCLUSION Children undergoing surgical pulmonary valve replacement with better preoperative exercise capacity had shorter total hospital length of stay. Exercise capacity is a potentially modifiable factor prior to and after pulmonary valve replacement. Until more patients systematically undergo cardiopulmonary exercise tests, the full impact of optimisation of exercise capacity will not be known.
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22
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Tompkins R, Garg R. Reduced exercise capacity in the adult with repaired tetralogy of Fallot: More evidence. Now what to do? INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Hager A. Minute ventilation/carbon dioxide production in congenital heart disease. Eur Respir Rev 2021; 30:30/161/200178. [PMID: 34526311 PMCID: PMC9488851 DOI: 10.1183/16000617.0178-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
This review summarises various applications of how ventilatory equivalent (ventilatory efficiency or better still ventilatory inefficiency) and the minute ventilation (VʹE)/carbon dioxide production (VʹCO2) slope obtained from cardiopulmonary exercise testing (CPET) can be used in the diagnostic or prognostic workup of patients with congenital heart disease. The field of congenital heart disease comprises not only a very heterogeneous patient group with various heart diseases, but also various conditions in different stages of repair, as well as the different residuals seen in long-term follow-up. As such, various physiologic disarrangements must be considered in the analysis of increased VʹE/VʹCO2 slope from CPET in patients with congenital heart disease. In addition to congestive heart failure (CHF), cyanosis, unilateral pulmonary stenosis and pulmonary hypertension (PH) provide the background for this finding. The predictive value of increased VʹE/VʹCO2 slope on prognosis seems to be more important in conditions where circulatory failure is associated with failure of the systemic ventricle. In cyanotic patients, those with Fontan circulation, or those with substantial mortality from arrhythmia, the impact of VʹE/VʹCO2 on prognosis is not that important. VʹE/VʹCO2 elevation is a common finding in patients with congenital heart disease. It can be used as a sign for right-to-left shunting, unilateral pulmonary stenosis, pulmonary hypertension and circulatory failure. It is predictive for clinical worsening.https://bit.ly/33gj3NQ
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Affiliation(s)
- Alfred Hager
- Dept of Pediatric Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
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24
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Wadey CA, Weston ME, Dorobantu DM, Pieles GE, Stuart G, Barker AR, Taylor RS, Williams CA. The role of cardiopulmonary exercise testing in predicting mortality and morbidity in people with congenital heart disease: a systematic review and meta-analysis. Eur J Prev Cardiol 2021; 29:513-533. [PMID: 34405863 DOI: 10.1093/eurjpc/zwab125] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/10/2021] [Indexed: 12/16/2022]
Abstract
AIMS The role of cardiopulmonary exercise testing (CPET) in predicting major adverse cardiovascular events (MACE) in people with congenital heart disease (ConHD) is unknown. A systematic review with meta-analysis was conducted to report the associations between CPET parameters and MACE in people with ConHD. METHODS AND RESULTS Electronic databases were systematically searched on 30 April 2020 for eligible publications. Two authors independently screened publications for inclusion, extracted study data, and performed risk of bias assessment. Primary meta-analysis pooled univariate hazard ratios across studies. A total of 34 studies (18 335 participants; 26.2 ± 10.1 years; 54% ± 16% male) were pooled into a meta-analysis. More than 20 different CPET prognostic factors were reported across 6 ConHD types. Of the 34 studies included in the meta-analysis, 10 (29%), 23 (68%), and 1 (3%) were judged as a low, medium, and high risk of bias, respectively. Primary univariate meta-analysis showed consistent evidence that improved peak and submaximal CPET measures are associated with a reduce risk of MACE. This association was supported by a secondary meta-analysis of multivariate estimates and individual studies that could not be numerically pooled. CONCLUSION Various maximal and submaximal CPET measures are prognostic of MACE across a variety of ConHD diagnoses. Further well-conducted prospective multicentre cohort studies are needed to confirm these findings.
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Affiliation(s)
- Curtis A Wadey
- Children's Health & Exercise Research Centre (CHERC), College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK
| | - Max E Weston
- Children's Health & Exercise Research Centre (CHERC), College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK.,School of Human Movement and Nutrition Sciences, Human Movement Studies Building, University of Queensland, QLD 4067, Brisbane, Australia
| | - Dan Mihai Dorobantu
- Children's Health & Exercise Research Centre (CHERC), College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK.,School of Population Health Sciences, University of Bristol, BS8 1QU, Bristol, UK
| | - Guido E Pieles
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Terrell St, BS2 8ED, Bristol, UK.,Bristol Congenital Heart Centre, The Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK.,Institute of Sport Exercise and Health (ISEH), University College London, 170 Tottenham Court Rd, W1T 7HA, London, UK
| | - Graham Stuart
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Terrell St, BS2 8ED, Bristol, UK.,Bristol Congenital Heart Centre, The Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, BS2 8HW, Bristol, UK
| | - Alan R Barker
- Children's Health & Exercise Research Centre (CHERC), College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, 99 Berkeley Street, G3 7HR, Glasgow, UK
| | - Craig A Williams
- Children's Health & Exercise Research Centre (CHERC), College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK
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Budts W, Pieles GE, Roos-Hesselink JW, Sanz de la Garza M, D'Ascenzi F, Giannakoulas G, Müller J, Oberhoffer R, Ehringer-Schetitska D, Herceg-Cavrak V, Gabriel H, Corrado D, van Buuren F, Niebauer J, Börjesson M, Caselli S, Fritsch P, Pelliccia A, Heidbuchel H, Sharma S, Stuart AG, Papadakis M. Recommendations for participation in competitive sport in adolescent and adult athletes with Congenital Heart Disease (CHD): position statement of the Sports Cardiology & Exercise Section of the European Association of Preventive Cardiology (EAPC), the European Society of Cardiology (ESC) Working Group on Adult Congenital Heart Disease and the Sports Cardiology, Physical Activity and Prevention Working Group of the Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2021; 41:4191-4199. [PMID: 32845299 DOI: 10.1093/eurheartj/ehaa501] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/16/2019] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
Improved clinical care has led to an increase in the number of adults with congenital heart disease (CHD) engaging in leisure time and competitive sports activities. Although the benefits of exercise in patients with CHD are well established, there is a low but appreciable risk of exercise-related complications. Published exercise recommendations for individuals with CHD are predominantly centred on anatomic lesions, hampering an individualized approach to exercise advice in this heterogeneous population. This document presents an update of the recommendations for competitive sports participation in athletes with cardiovascular disease published by the Sports Cardiology & Exercise section of the European Association of Preventive Cardiology (EAPC) in 2005. It introduces an approach which is based on the assessment of haemodynamic, electrophysiological and functional parameters, rather than anatomic lesions. The recommendations provide a comprehensive assessment algorithm which allows for patient-specific assessment and risk stratification of athletes with CHD who wish to participate in competitive sports.
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Affiliation(s)
- Werner Budts
- Department of Congenital and Structural Cardiology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, B- 3000 Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Campus Gasthuisberg, Herestraat 49, B- 3000 Leuven, Belgium
| | - Guido E Pieles
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Maria Sanz de la Garza
- Cardiovascular Institute, Hospital Clinic, Calle Villarroel, 170, 08036 Barcelona, Spain
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, 546 37 Thessaloniki, Greece
| | - Jan Müller
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, German Heart Center, Technical University Munich, Georg-Brauchle-Ring 60/62 80992 München, Germany
| | - Renate Oberhoffer
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, German Heart Center, Technical University Munich, Georg-Brauchle-Ring 60/62 80992 München, Germany
| | - Doris Ehringer-Schetitska
- Department of Pediatrics and Adolescent Medicine, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
| | - Vesna Herceg-Cavrak
- Pediatric Cardiology Department, Faculty of Dental Medicine and Health Osijek, Children's Hospital Zagreb, Libertas International University and University of Applied Health Sciences, Klaićeva 16, 10000 Zagreb, Croatia
| | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna/General Hospital Vienna, 1090 Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via Giustiniani 2, 35121 Padova, Italy
| | - Frank van Buuren
- Department of Internal Medicine, Catholic Hospital Southwestfalia-St. Martinus-Hospital Olpe, Angiology and Intensive Care Unit, Hospitalweg 6, 57462 Olpe, Germany
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Mats Börjesson
- Department of Neuroscience and Physiology, Sahlgrenska Academy and Center for Health and Performance, Göteborg University and Sahlgrenska University Hospital/Ostra, Medicinaregatan 11-13, 413 90 Göteborg, Sweden
| | - Stefano Caselli
- Cardiovascular Center Zurich, Hirslanden Klinik im Park, Seestrasse 220, 8027 Zürich, Switzerland
| | - Peter Fritsch
- Institute for Paediatric Cardiology, University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria
| | - Antonio Pelliccia
- Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, Tooting, London SW17 0QT, UK
| | - A Graham Stuart
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, Tooting, London SW17 0QT, UK
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26
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Maximal versus sub-maximal effort during cardiopulmonary exercise testing in adults with congenital heart disease: outcome analysis of short-term cardiac-related events. Cardiol Young 2021; 31:91-96. [PMID: 33070792 DOI: 10.1017/s104795112000339x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Peak respiratory exchange ratio is an objective marker of patient effort during cardiopulmonary exercise testing. We evaluated exercise variables in 175 adult congenital heart disease patients and the impact of respiratory exchange ratio on the prognostic value of exercise variables for short-term cardiac-related events. Of 175 patients, 110 completed the exercise test with a peak respiratory exchange ratio of ≥1.10 and the remaining 65 had a peak respiratory exchange ratio of <1.10. Peak oxygen consumption, the percentage of oxygen consumption at the ventilatory threshold, peak heart rate, percentage predicted peak heart rate, double product, oxygen uptake efficiency slope, and the number of patients with exercise oscillatory ventilation were reduced significantly in patients with a respiratory exchange ratio of <1.10 compared to those with a respiratory exchange ratio of ≥1.10. After a median follow-up of 21 months, total cardiac-related events occurred in 37 (21%) patients. Multivariate Cox proportional hazard analysis showed that the percentage predicted peak oxygen consumption, and oxygen uptake efficiency slope were independent predictors of cardiac-related events only in patients with a peak respiratory exchange ratio of ≥1.10. Sub-maximal exercise performance can be preserved in adult congenital heart disease patients. The percentage predicted oxygen consumption and the oxygen uptake efficiency slope are two independent predictors for short-term cardiac-related events in adult congenital heart disease patients.
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Goldberg DJ, Zak V, McCrindle BW, Ni H, Gongwer R, Rhodes J, Garofano RP, Kaltman JR, Lambert LM, Mahony L, Margossian R, Spector ZZ, Williams RV, Atz AM, Paridon SM. Exercise Capacity and Predictors of Performance After Fontan: Results from the Pediatric Heart Network Fontan 3 Study. Pediatr Cardiol 2021; 42:158-168. [PMID: 32975603 PMCID: PMC7867583 DOI: 10.1007/s00246-020-02465-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/16/2020] [Indexed: 12/22/2022]
Abstract
Impaired exercise following Fontan is a surrogate of morbidity. Single-center longitudinal data exist, but there is a lack of contemporary multi-center data. Ramp cycle ergometry was re-performed in consented participants who had originally participated in the Pediatric Heart Network's Fontan cross-sectional study. Annualized change was evaluated at maximal and submaximal exercise. Associations between these outcomes and patient characteristics were analyzed. There were 336 participants in Fontan 3, mean age 23.2 years. Paired measurements of peak oxygen consumption (peak VO2) were available for 95; peak exercise data at Fontan 3 were available for 275. Percent-predicted peak VO2 declined by 0.8 ± 1.7% per year (p < 0.001). At Fontan 3, the lowest performing peak VO2 tertile had the highest rate of overweight and obesity (p < 0.001). Female gender was more prevalent in the highest performing tertile (p = 0.004). Paired data at the ventilatory anaerobic threshold (VO2 at VAT) were available for 196; VAT data at Fontan 3 were available for 311. Percent-predicted VO2 at VAT decreased by 0.8 ± 2.6% per year (p < 0.001). At Fontan 3, VO2 at VAT was better preserved than peak VO2 across all tertiles, with higher rates of overweight and obesity in the lower performing group (p = 0.001). Female gender (p < 0.001) and left ventricular morphology (p = 0.03) were associated with better performance. Submaximal exercise is better preserved than maximal in the Fontan population, but declined at the same rate over the study period. The overall longitudinal rate of decline in exercise performance is slower than what has been described previously.
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Affiliation(s)
- David J. Goldberg
- Division of Cardiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA
| | | | - Brian W. McCrindle
- The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Hua Ni
- Healthcore, Watertown, MA 02472, USA
| | | | - Jonathan Rhodes
- Children’s Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
| | - Robert P. Garofano
- Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | - Jonathan R. Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892, USA
| | - Linda M. Lambert
- Primary Children’s Hospital, University of Utah, Salt Lake City, UT 84132, USA
| | - Lynn Mahony
- Children’s Health Dallas, University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Renee Margossian
- Children’s Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
| | | | - Richard V. Williams
- Primary Children’s Hospital, University of Utah, Salt Lake City, UT 84132, USA
| | - Andrew M. Atz
- Medical University of South Carolina, Charleston, SC 29425, USA
| | - Stephen M. Paridon
- Division of Cardiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA
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28
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van den Bosch E, Cuypers JAAE, Luijnenburg SE, Duppen N, Boersma E, Budde RPJ, Krestin GP, Blom NA, Breur HMPJ, Snoeren MM, Roos-Hesselink JW, Kapusta L, Helbing WA. Ventricular response to dobutamine stress cardiac magnetic resonance imaging is associated with adverse outcome during 8-year follow-up in patients with repaired Tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 2020; 21:1039-1046. [PMID: 31596460 PMCID: PMC7440962 DOI: 10.1093/ehjci/jez241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/16/2019] [Accepted: 09/06/2019] [Indexed: 11/15/2022] Open
Abstract
AIMS The aim of this study was to evaluate the possible value of dobutamine stress cardiac magnetic resonance imaging (CMR) to predict adverse outcome in Tetralogy of Fallot (TOF) patients. METHODS AND RESULTS In previous prospective multicentre studies, TOF patients underwent low-dose dobutamine stress CMR (7.5 µg/kg/min). Subsequently, during regular-care patient follow-up, patients were assessed for reaching the composite endpoint (cardiac death, arrhythmia-related hospitalization, or cardioversion/ablation, VO2 max ≤65% of predicted). A normal stress response was defined as a decrease in end-systolic volume (ESV) and increase in ejection fraction. The relative parameter change during stress was calculated as relative parameter change = [(parameterstress - parameterrest)/parameterrest] * 100. The predictive value of dobutamine stress CMR for the composite endpoint was determined using time-to-event analyses (Kaplan-Meier) and Cox proportional hazard analysis. We studied 100 patients [67 (67%) male, median age at baseline CMR 17.8 years (interquartile range 13.5-34.0), age at TOF repair 0.9 years (0.6-2.1)]. After a median follow-up of 8.6 years (6.7-14.1), 10 patients reached the composite endpoint. An abnormal stress response (30% vs. 4.4%, P = 0.021) was more frequently observed in composite endpoint patients. Also in endpoint patients, the relative decrease in right ventricular ESV decreased less during stress compared with the patients without an endpoint (-17 ± 15 vs. -26 ± 13 %, P = 0.045). Multivariable analyses identified an abnormal stress response (hazard ratio 10.4; 95% confidence interval 2.5-43.7; P = 0.001) as predictor for the composite endpoint. CONCLUSION An abnormal ventricular response to dobutamine stress is associated with adverse outcome in patients with repaired TOF.
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Affiliation(s)
- Eva van den Bosch
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3000 CM Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Saskia E Luijnenburg
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3000 CM Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Nienke Duppen
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3000 CM Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Hans M P J Breur
- Division of Pediatric Cardiology, Department of Pediatrics, University Medical Centre Utrecht, Lundlaan 6, 3508 AB Utrecht, The Netherlands
| | - Miranda M Snoeren
- Department of Radiology, Radboud University Medical Center, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Livia Kapusta
- Division of Pediatric Cardiology, Department of Pediatrics, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Weizmann street, 64239 Tel Aviv, Israel.,Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands
| | - Willem A Helbing
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3000 CM Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands
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Cardiopulmonary Exercise Test (CPET) in patients with repaired Tetralogy of Fallot (rTOF); A systematic review. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2020. [DOI: 10.1016/j.ijcchd.2020.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hiremath G, Qureshi AM, Meadows J, Aggarwal V. Treatment approach to unilateral branch pulmonary artery stenosis. Trends Cardiovasc Med 2020; 31:179-184. [PMID: 32081565 DOI: 10.1016/j.tcm.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/17/2022]
Abstract
Unilateral proximal pulmonary artery stenosis is often seen in the setting of postoperative congenital heart disease. Accurate assessment of the hemodynamic significance of such a lesion is important so as to determine "When to intervene?" A thorough evaluation should include symptom assessment, anatomical assessment through detailed imaging, functional assessment using differential pulmonary blood flow measurement and cardiopulmonary exercise testing. Symptoms of exertional dyspnea or intolerance, decreased pulmonary blood flow to stenosed lung, and abnormal exertional performance would be factors to pursue therapy in the setting of significant anatomical narrowing. Safe and effective therapy can be offered through transcatheter or surgical techniques and has been shown to improve exertional performance.
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Affiliation(s)
- Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN 55454, USA.
| | - Athar M Qureshi
- The Lillie Frank Abercrombie section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA
| | - Jeffery Meadows
- Department of Pediatrics, UCSF Benioff Children's Hospital and the University of California, San Francisco, San Francisco, CA 94118, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN 55454, USA
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31
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Right ventricular free wall strain predicts functional capacity in patients with repaired Tetralogy of Fallot. Int J Cardiovasc Imaging 2020; 36:595-604. [DOI: 10.1007/s10554-019-01753-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
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Sawyer A, Lewthwaite H, Gucciardi DF, Hill K, Jenkins S, Cavalheri V. Behaviour change techniques to optimise participation in physical activity or exercise in adolescents and young adults with chronic cardiorespiratory conditions: a systematic review. Intern Med J 2019; 49:1209-1220. [DOI: 10.1111/imj.14141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/11/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Abbey Sawyer
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
- Physiotherapy DepartmentSir Charles Gairdner Hospital Perth Western Australia Australia
- Institute for Respiratory Health Perth Western Australia Australia
| | - Hayley Lewthwaite
- Alliance for Research in Exercise, Nutrition and Activity, School of Health ScienceUniversity of South Australia Adelaide South Australia Australia
| | - Daniel F. Gucciardi
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
- Institute for Respiratory Health Perth Western Australia Australia
| | - Sue Jenkins
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
- Physiotherapy DepartmentSir Charles Gairdner Hospital Perth Western Australia Australia
- Institute for Respiratory Health Perth Western Australia Australia
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
- Institute for Respiratory Health Perth Western Australia Australia
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34
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Edelson JB, Burstein DS, Paridon S, Stephens P. Exercise stress testing: A valuable tool to predict risk and prognosis. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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36
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Akamagwuna U, Badaly D. Pediatric Cardiac Rehabilitation: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00216-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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37
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Priromprintr B, Silka MJ, Rhodes J, Batra AS. A prospective 5-year study of exercise performance following Melody valve implant. Am Heart J 2019; 209:47-53. [PMID: 30682562 DOI: 10.1016/j.ahj.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 12/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The long-term benefits of Melody valve implant for right ventricular outflow tract conduit obstruction or insufficiency on exercise capacity are undefined. METHODS As part of the Melody valve clinical trial, 136 patients with congenital heart disease underwent serial cardiopulmonary exercise testing prior to, 6 months after, and annually for up to 5 years postimplant. RESULTS Mean age at Melody valve implantation was 22.4 ± 0.9 years (range 7-53 years). The 95 patients who completed the study protocol provide the basis of this report. An initial improvement in % predicted workload was present at 6 months postimplant; however, at the final (5 year) follow-up, sustained or further improvements in workload were not demonstrated for the entire cohort compared to baseline. By subgroup analysis, age <17 years at implant and pulmonary regurgitation as the primary lesion were variables associated with sustained improvement in exercise performance. There were sustained improvements in the ventilatory equivalents for O2 (minute ventilation/O2 intake, P = .01) and CO2 (minute ventilation/CO2 output, P < .01) at the ventilatory anaerobic threshold at the study conclusion. Improvements in forced vital capacity were also observed during the study but not sustained at the final follow-up. CONCLUSIONS A cautious appraisal of the cardiovascular benefits of Melody valve implant on sustained improvements in exercise performance appears warranted. Although the observed changes in pulmonary function suggest improved restrictive lung physiology and more efficient gas exchange, after an initial increase in % predicted performance, neither sustained nor further improvements in exercise performance were observed, except in specific patient subgroups.
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Affiliation(s)
- Bryant Priromprintr
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA; Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
| | - Michael J Silka
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA.
| | | | - Anjan S Batra
- Children's Hospital of Orange County, University of California, Irvine, CA.
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38
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Bhatt SM, Elci OU, Wang Y, Goldmuntz E, McBride M, Paridon S, Mercer-Rosa L. Determinants of Exercise Performance in Children and Adolescents with Repaired Tetralogy of Fallot Using Stress Echocardiography. Pediatr Cardiol 2019; 40:71-78. [PMID: 30121867 PMCID: PMC6349539 DOI: 10.1007/s00246-018-1962-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/11/2018] [Indexed: 01/07/2023]
Abstract
Exercise performance is variable and often impaired in patients with repaired tetralogy of Fallot (rTOF). We sought to identify factors associated with exercise performance by comparing high to low performers on cardiopulmonary exercise testing (CPET) in patients with rTOF. We conducted a cross-sectional study of subjects presenting for CPET who underwent echocardiograms at rest and peak exercise. Patients with pacemakers and arrhythmias were excluded. Right ventricular (RV) global longitudinal strain was used as a measure of systolic function. Pulmonary insufficiency (PI) was assessed with the diastolic systolic ratio and the diastolic systolic time-velocity integral ratio by Doppler interrogation of the pulmonary artery. CPET measures included percent-predicted maximum [Formula: see text][Formula: see text], percent-predicted maximum work and oxygen pulse. High versus low performers were identified as those achieving [Formula: see text] of at least 80% or falling below, respectively. Differences in echocardiographic parameters from rest to peak exercise were examined using mixed-effects regression models. Compared to the low performers (n = 17), high performers (n = 12) were younger (12.8 ± 3.3 years vs. 18.3 ± 4.8 years), had normal chronotropic response (peak heart rate > 185 bpm) with greater heart rate reserve and superior physical working capacity. High performers also had a greater reduction in PI at peak exercise, despite greater PI severity at rest. Oxygen pulse was comparable between groups. For both groups, there was no association of PI severity and RV systolic function at rest with exercise parameters. There was no group difference in the magnitude of change in RV strain and diastolic parameters from rest to peak exercise. Chronotropic response to exercise appears to be an important parameter with which to assess exercise performance in rTOF. Chronotropic health should be taken into consideration in this population, particularly given that RV function and PI severity at rest were not associated with exercise performance.
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Affiliation(s)
- Shivani M Bhatt
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Okan U Elci
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yan Wang
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Elizabeth Goldmuntz
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Michael McBride
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephen Paridon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Laura Mercer-Rosa
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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39
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Shafer KM, Opotowsky AR, Rhodes J. Exercise testing and spirometry as predictors of mortality in congenital heart disease: Contrasting Fontan physiology with repaired tetralogy of Fallot. CONGENIT HEART DIS 2018; 13:903-910. [DOI: 10.1111/chd.12661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/17/2018] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Keri M. Shafer
- Department of Cardiology; Boston Children’s Hospital; Boston Massachusetts
- Division of Cardiology; Brigham and Women’s Hospital; Boston Massachusetts
| | - Alexander R. Opotowsky
- Department of Cardiology; Boston Children’s Hospital; Boston Massachusetts
- Division of Cardiology; Brigham and Women’s Hospital; Boston Massachusetts
| | - Jonathan Rhodes
- Department of Cardiology; Boston Children’s Hospital; Boston Massachusetts
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40
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Marino P, de Oliveira Lopes G, Pereira Borges J, Carolina Terra Cola M, Arkader Kopiler D, Tibirica E. Evaluation of systemic microvascular reactivity in adults with congenital heart disease. CONGENIT HEART DIS 2018; 13:978-987. [DOI: 10.1111/chd.12660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/15/2018] [Accepted: 07/15/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Pablo Marino
- National Institute of Cardiology; Rio de Janeiro Brazil
- Antônio Pedro University Hospital, Federal Fluminense University; Niteroi Brazil
| | - Gabriella de Oliveira Lopes
- National Institute of Cardiology; Rio de Janeiro Brazil
- Laboratory of Physical Activity and Health Promotion, Department of Collective Sports, Institute of Physical Education and Sports; Rio de Janeiro State University; Rio de Janeiro Brazil
| | - Juliana Pereira Borges
- Laboratory of Physical Activity and Health Promotion, Department of Collective Sports, Institute of Physical Education and Sports; Rio de Janeiro State University; Rio de Janeiro Brazil
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Udholm S, Aldweib N, Hjortdal VE, Veldtman GR. Prognostic power of cardiopulmonary exercise testing in Fontan patients: a systematic review. Open Heart 2018; 5:e000812. [PMID: 30057765 PMCID: PMC6059270 DOI: 10.1136/openhrt-2018-000812] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/03/2018] [Accepted: 04/24/2018] [Indexed: 11/04/2022] Open
Abstract
Objective Exercise impairment is common in Fontan patients. Our aim is to systematically review previous literature to determine the prognostic value of exercise capacity in older adolescent and adult Fontan patients with respect to late outcome. Additionally, we reviewed the determinants of exercise capacity in Fontan patients and changes in exercise capacity over time. Methods PubMed, CINAHL, Embase, The Cochrane Library and Scopus were searched systematically for studies reporting exercise capacity and late outcome such as mortality, cardiac transplantation and hospitalisation. Studies were eligible for inclusion if more than 30 patients were included and mean age was ≥16 years. Results Four thousand and seven hundred and twenty-two studies were identified by the systematic search. Seven studies fulfilled the inclusion and exclusion criteria. The total number of patients was 1664 adult Fontan patients. There were 149 deaths and 35 heart transplantations. All eligible studies were retrospective cohort studies. The correlation between exercise capacity and late outcome was identified, and HRs were reported. Conclusion In Fontan patients, the best predictors of death and transplantation were a decline in peak VO2, heart rate variables and exercise oscillatory ventilation. Peak VO2 was not strongly predictive of mortality or hospitalisation in Fontan patients. Several variables were strong and independent predictors of hospitalisation and morbidity.
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Affiliation(s)
- Sebastian Udholm
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nael Aldweib
- Cardiovascular Medicine Department, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Gruschen R Veldtman
- Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
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Design and rationale of the Fontan Udenafil Exercise Longitudinal (FUEL) trial. Am Heart J 2018; 201:1-8. [PMID: 29910047 DOI: 10.1016/j.ahj.2018.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/24/2018] [Indexed: 11/23/2022]
Abstract
The Fontan operation creates a circulation characterized by elevated central venous pressure and low cardiac output. Over time, these characteristics result in a predictable and persistent decline in exercise performance that is associated with an increase in morbidity and mortality. A medical therapy that targets the abnormalities of the Fontan circulation might, therefore, be associated with improved outcomes. Udenafil, a phosphodiesterase type 5 inhibitor, has undergone phase I/II testing in adolescents who have had the Fontan operation and has been shown to be safe and well tolerated in the short term. However, there are no data regarding the long-term efficacy of udenafil in this population. The Fontan Udenafil Exercise Longitudinal (FUEL) Trial is a randomized, double-blind, placebo-controlled phase III clinical trial being conducted by the Pediatric Heart Network in collaboration with Mezzion Pharma Co, Ltd. This trial is designed to test the hypothesis that treatment with udenafil will lead to an improvement in exercise capacity in adolescents who have undergone the Fontan operation. A safety extension trial, the FUEL Open-Label Extension Trial (FUEL OLE), offers the opportunity for all FUEL subjects to obtain open-label udenafil for an additional 12 months following completion of FUEL, and evaluates the long-term safety and tolerability of this medication. This manuscript describes the rationale and study design for FUEL and FUEL OLE. Together, these trials provide an opportunity to better understand the role of medical management in the care of those who have undergone the Fontan operation.
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Ramos SR, Pieles G, Sun M, Slorach C, Hui W, Friedberg MK. Early versus late cardiac remodeling during right ventricular pressure load and impact of preventive versus rescue therapy with endothelin-1 receptor blockers. J Appl Physiol (1985) 2018; 124:1349-1362. [DOI: 10.1152/japplphysiol.00975.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pulmonary artery banding (PAB) causes right ventricular (RV) dysfunction, biventricular fibrosis, and apoptosis, which are attenuated by endothelin-1 receptor blockade (ERB). Little is known about the time course of remodeling and whether early versus late ERB confers improved outcome. PAB was performed in five groups of rabbits: Shams, 3-wk PAB (3W), 6-wk PAB (6W), 6-wk PAB + ERB administered from day 1 (6WERB1), and 6-wk PAB + ERB administered from day 21 (6WERB21). Biventricular development of profibrotic molecular signaling, fibrosis, apoptosis, and conductance catheter and echocardiography function were studied. Thirty-three rabbits [ n = 6–7 per group; 3.00 (0.23) kg, mean (SD)] developed half to full systemic RV pressures. Biventricular profibrotic signaling and collagen deposition [RV collagen: Shams 3.8 (0.58) vs. 3W 8.69 (2.52) vs. 6W 8.83 (4.02)%, P < 0.005] and apoptosis [RV: Shams 8.32 (3.2) vs. 3W 55.95 (47.55) vs. 6W 38.85 (17.26) apoptotic cells per microfield, P < 0.0005] increased with PAB. Early and late ERB attenuated fibrosis [RV: 6WERB1 5.55 (1.18), 6WERB21 5.63 (0.72)%] and apoptosis [RV: 6WERB1 11.1 (5.25), 6WERB21 20.24 (7.16) apoptotic cells per microfield, P < 0.0001 vs. 6W]. RV dimensions progressively increased at 3W and 6W and decreased with early ERB [end-diastolic dimensions: Shams 0.4 (0.13) vs. 3W 0.55 (0.78) vs. 6W 0.78 (0.25) vs. 6WERB1 0.71 (0.26) vs. 6WERB21 0.49 (0.23) cm, P < 0.05]. Despite increased RV contractility with PAB [RV end-systolic pressure-volume relationship: Shams 3.76 (1.76) vs. 3W 12.21 (3.44) vs. 6W 19.4 (6.88) mmHg/ml], biventricular function and cardiac output [Shams 196.1 (39.73) vs. 3W 149.9 (34.82) vs. 6W 151 (31.69) ml/min] worsened in PAB groups and improved with early and late ERB [6WERB1 202.8 (26.8), 6WERB21 194.8 (36.93) ml/min, P < 0.05 vs. PAB]. In conclusion, RV pressure overload induces early biventricular fibrosis, apoptosis, remodeling, and dysfunction that worsens with persistent RV hypertension. This remodeling is attenuated by early and late ERB. NEW & NOTEWORTHY Our results in a rabbit model of progressive right ventricular (RV) pressure loading indicate that biventricular fibrosis, apoptosis, and dysfunction are already present when RV hypertension is reached at 3 wk of progressive pulmonary artery banding. These findings worsen with persistent RV hypertension to 6 wk and are attenuated with both early and late endothelin-1 receptor blockade, with some advantages to early therapy. These findings highlight the role of endothelin-1 in driving biventricular remodeling secondary to RV hypertension and suggest that early therapy with an endothelin-1 receptor blocker may be beneficial in attenuating biventricular remodeling but that late therapy is also effective.
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Affiliation(s)
- Sara Roldan Ramos
- The Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Department of Congenital Cardiovascular Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
- Departments of Congenital Cardiac Surgery and Pediatric Cardiology, Bristol Heart Institute and Hospital for Sick Children, Bristol, United Kingdom
| | - Guido Pieles
- The Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Departments of Congenital Cardiac Surgery and Pediatric Cardiology, Bristol Heart Institute and Hospital for Sick Children, Bristol, United Kingdom
| | - Mei Sun
- The Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Cameron Slorach
- The Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wei Hui
- The Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Mark K. Friedberg
- The Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Roldan Ramos S, Pieles G, Hui W, Slorach C, Redington AN, Friedberg MK. A rabbit model of progressive chronic right ventricular pressure overload. Interact Cardiovasc Thorac Surg 2018; 26:673-680. [PMID: 29211855 DOI: 10.1093/icvts/ivx372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 10/14/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Right ventricular (RV) failure from increased pressure loading is a frequent consequence of acquired and congenital heart diseases. However, the mechanisms involved in their pathophysiology are still unclear, and few data exist on RV pressure-loading models and early versus late effects on RV and left ventricular responses. We characterized a rabbit model of chronic RV pressure overload and early-late effects on biventricular function. METHODS Twenty-one New Zealand white rabbits were randomized into 3 groups: (i) sham, (ii) pulmonary artery (PA) banding (PAB) for 3 weeks (PAB3W) and (iii) PAB for 6 weeks (PAB6W). Progressive RV pressure overload was created by serial band inflation using an adjustable device. Molecular, echocardiographic and haemodynamic studies were performed. RESULTS RV pressure overload was achieved with clinical manifestations of RV failure. Heart and liver weights were significantly higher after PAB. PAB-induced echocardiographic ventricular remodelling increased wall thickness and stress and ventricular dilation. Cardiac output (ml/min) (sham 172.4 ± 42.86 vs PAB3W 103.1 ± 23.14 vs PAB6W 144 ± 60.9, P = 0.0027) and systolic and diastolic functions decreased; with increased RV end-systolic and end-diastolic pressures (mmHg) (sham 1.6 ± 0.66 vs PAB3W 3.9 ± 1.8 vs PAB6W 5.2 ± 2.2, P = 0.0103), despite increased contractility [end-systolic pressure-volume relationship (mmHg/ml), sham 3.76 ± 1.76 vs PAB3W 12.21 ± 3.44 vs PAB6W 19.4 ± 6.88, P < 0.0001]. Functional parameters further worsened after PAB6W versus PAB3W. LV contractility increased in both the PAB groups, despite worsening of other invasive measures of systolic and diastolic functions. CONCLUSIONS We describe a novel, unique model of chronic RV pressure overload leading to early biventricular dysfunction and fibrosis with further progression at 6 weeks. These findings can aid in guiding management.
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Affiliation(s)
- Sara Roldan Ramos
- Department of Paediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Congenital Cardiac Surgery, Bristol Heart Institute and Hospital for Sick Children, Bristol, UK
| | - Guido Pieles
- Department of Paediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatric Cardiology, Bristol Heart Institute and Hospital for Sick Children, Bristol, UK
| | - Wei Hui
- Department of Paediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Cameron Slorach
- Department of Paediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Andrew N Redington
- Department of Paediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Mark K Friedberg
- Department of Paediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada
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Blom KJ, Takken T, Huijgen BCH, Wienke J, van Royen-Kerkhof A, van Brussel M. Trajectories of cardiorespiratory fitness in patients with juvenile dermatomyositis. Rheumatology (Oxford) 2017; 56:2204-2211. [PMID: 29029283 DOI: 10.1093/rheumatology/kex366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives Previous research demonstrated decreased cardiorespiratory fitness (CRF) in patients with JDM during active disease and remission. However, longitudinal data regarding trajectories of CRF are currently lacking. The objective of this study was to determine trajectories of CRF in patients with both monocyclic and chronic JDM, and to identify potential predictors of these trajectories. Methods Thirty-six patients with JDM [median age (interquartile range) at diagnosis: 8.3 (6.3-15.4) years] treated in our paediatric rheumatology outpatient clinic were included. All patients performed multiple cardiopulmonary exercise tests between 2003 and 2016. Relevant CRF parameters were analysed, including peak oxygen uptake, maximal workload, mechanical efficacy and oxygen uptake at ventilatory anaerobic threshold. We analysed trajectories up to 10 years after diagnosis and determined predictors of CRF outcome parameters by multilevel analyses. Results Trajectories demonstrated significant declines in CRF during the active phase of the disease with subsequent improvement in CRF during the initial years after diagnosis. However, hereafter no further improvements, and even a decrease, in CRF were observed over time in both monocyclic and chronic subtypes of JDM. We found that a longer disease duration, younger age of onset and higher prednisone dose negatively influence CRF. Conclusion Patients with both monocyclic and chronic JDM show decreases in long-term CRF trajectories. Longer disease duration, younger age of onset and higher prednisone dose negatively influence CRF. This study stresses the need for regular evaluation of CRF and implementation of (exercise) interventions to improve CRF in patients with JDM, even in monocyclic patients.
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Affiliation(s)
- Kiki J Blom
- Child Development and Exercise Centre, Wilhelmina Children's Hospital, University Medical Centre Utrecht.,Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen
| | - Tim Takken
- Child Development and Exercise Centre, Wilhelmina Children's Hospital, University Medical Centre Utrecht
| | - Barbara C H Huijgen
- Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen
| | - Judith Wienke
- Paediatric Immunology, Laboratory of Translational Immunology LTI
| | - Annet van Royen-Kerkhof
- Department of paediatric rheumatology/immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, the Netherlands
| | - Marco van Brussel
- Child Development and Exercise Centre, Wilhelmina Children's Hospital, University Medical Centre Utrecht
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Li WF, Pollard H, Karimi M, Asnes JD, Hellenbrand WE, Shabanova V, Weismann CG. Comparison of valvar and right ventricular function following transcatheter and surgical pulmonary valve replacement. CONGENIT HEART DIS 2017; 13:140-146. [PMID: 29148206 DOI: 10.1111/chd.12544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/22/2017] [Accepted: 09/22/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Trans-catheter (TC) pulmonary valve replacement (PVR) has become common practice for patients with right ventricular outflow tract obstruction (RVOTO) and/or pulmonic insufficiency (PI). Our aim was to compare PVR and right ventricular (RV) function of patients who received TC vs surgical PVR. DESIGN Retrospective review of echocardiograms obtained at three time points: before, immediately after PVR, and most recent. PATIENTS Sixty-two patients (median age 19 years, median follow-up 25 months) following TC (N = 32) or surgical (N = 30) PVR at Yale-New Haven Hospital were included. OUTCOME MEASURES Pulmonary valve and right ventricular function before, immediately after, and most recently after PVR. RESULTS At baseline, the TC group had predominant RVOTO (74% vs 10%, P < .001), and moderate-severe PI was less common (61% vs 100%, P < .001). Immediate post-procedural PVR function was good throughout. At last follow-up, the TC group had preserved valve function, but the surgical group did not (moderate RVOTO: 6% vs 41%, P < .001; >mild PI: 0% vs 24%, P = .003). Patients younger than 17 years at surgical PVR had the highest risk of developing PVR dysfunction, while PVR function in follow-up was similar in adults. Looking at RV size and function, both groups had a decline in RV size following PVR. However, while RV function remained stable in the TC group, there was a transient postoperative decline in the surgical group. CONCLUSIONS TC PVR in patients age <17 years is associated with better PVR function in follow-up compared to surgical valves. There was a transient decline in RV function following surgical but not TC PVR. TC PVR should therefore be the first choice in children who are considered for PVR, whenever possible.
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Affiliation(s)
- Wendy F Li
- Department of Pediatrics, Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Heidi Pollard
- Pediatric Echocardiography Laboratory, Yale New Haven Children's Hospital, New Haven, CT, USA
| | - Mohsen Karimi
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jeremy D Asnes
- Department of Pediatrics, Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - William E Hellenbrand
- Department of Pediatrics, Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Constance G Weismann
- Department of Pediatrics, Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA.,Department of Pediatric Surgery, Division of Pediatric Cardiology, Pediatric Heart Center, Skåne Universitetssjukhus, Lund, Sweden
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Ramos SR, Pieles G, Hui W, Ishii R, Slorach C, Friedberg MK. Comprehensive echocardiographic assessment of biventricular function in the rabbit, animal model in cardiovascular research: feasibility and normal values. Int J Cardiovasc Imaging 2017; 34:367-375. [PMID: 28840383 DOI: 10.1007/s10554-017-1238-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/21/2017] [Indexed: 11/26/2022]
Abstract
Quantification of cardiac structure and function is central in cardiovascular research. Rabbits are valuable research models of cardiovascular human disease; however, there is little normal data available. The aim of this study was to investigate feasibility and provide normal values for comprehensive echocardiographic assessment of biventricular function in rabbits. New Zealand white rabbits underwent trans-thoracic echocardiography using a general electric (GE) Vivid 7/E9 system with a 10 MHz transducer, under light sedation, to evaluate biventricular function and dimensions. Images for two-dimensional, M-mode, tissue Doppler imaging (TDI) and speckle-tracking strain echocardiography were acquired and analysed. 55 male rabbits (sized matched with a newborn human baby) were studied, mean weight was 2.9 ± 0.23 kg. Adequate images were obtained in 90% for the left ventricle (LV) and 80% for the right ventricle (RV). Two-dimensional speckle-tracking strain was feasible in 60%. Average heart rate was 248 ± 36 beats per minute; LV ejection faction 72 ± 8.0; RV fractional area change 45.9 ± 9.0%; RV myocardial performance index 0.39 ± 0.35; tricuspid annular planar systolic excursion 0.60 ± 0.24 cm. LV TDI parameters were S' 8.6 ± 3.1 cm/s; E' 12.0 ± 4.46 cm/s. RV TDI parameters were S' 10.49 ± 3.18; E' 14.95 ± 4.64 cm/s. LV and RV global peak systolic longitudinal strain were -17 ± 5 and -22 ± 8%, respectively. Comprehensive investigation of biventricular dimensions and function by echocardiography is feasible in the rabbit. Apical views and strain imaging have lower feasibility. Normal values of LV and RV functional parameters are with comparable values to human children. Animal cardiovascular research is key to develop new goals in clinical practice.
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Affiliation(s)
- Sara Roldan Ramos
- The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Department of Congenital Cardiac Surgery and Paediatric Cardiology, Bristol Heart Institute and Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK.
| | - Guido Pieles
- The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Congenital Cardiac Surgery and Paediatric Cardiology, Bristol Heart Institute and Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK
| | - Wei Hui
- The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Ryo Ishii
- The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Cameron Slorach
- The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Mark K Friedberg
- The Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Cohen KE, Buelow MW, Dixon J, Brazauskas R, Cohen SB, Earing MG, Ginde S. Forced vital capacity predicts morbidity and mortality in adults with repaired tetralogy of Fallot. CONGENIT HEART DIS 2017; 12:435-440. [DOI: 10.1111/chd.12470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/07/2017] [Accepted: 04/02/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Katie E. Cohen
- Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Matthew W. Buelow
- Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Jennifer Dixon
- Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Ruta Brazauskas
- Department of Biostatistics; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Scott B. Cohen
- Department of Internal Medicine; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Michael G. Earing
- Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
- Department of Internal Medicine; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Salil Ginde
- Department of Pediatrics; Medical College of Wisconsin; Milwaukee Wisconsin
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Noninvasive Screening for Pulmonary Hypertension by Exercise Testing in Congenital Heart Disease. Ann Thorac Surg 2017; 103:1544-1549. [DOI: 10.1016/j.athoracsur.2016.09.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022]
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