1
|
Roos-Hesselink JW, Pelosi C, Brida M, De Backer J, Ernst S, Budts W, Baumgartner H, Oechslin E, Tobler D, Kovacs AH, Di Salvo G, Kluin J, Gatzoulis MA, Diller GP. Surveillance of adults with congenital heart disease: Current guidelines and actual clinical practice. Int J Cardiol 2024; 407:132022. [PMID: 38636602 DOI: 10.1016/j.ijcard.2024.132022] [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] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND AIM Congenital heart disease (CHD) is the most common birth defect with prevalence of 0.8%. Thanks to tremendous progress in medical and surgical practice, nowadays, >90% of children survive into adulthood. Recently European Society of Cardiology (ESC), American College of Cardiology (ACC)/ American Heart Association (AHA) issued guidelines which offer diagnostic and therapeutic recommendations for the different defect categories. However, the type of technical exams and their frequency of follow-up may vary largely between clinicians and centres. We aimed to present an overview of available diagnostic modalities and describe current surveillance practices by cardiologists taking care of adults with CHD (ACHD). METHODS AND RESULTS A questionnaire was used to assess the frequency cardiologists treating ACHD for at least one year administrated the most common diagnostic tests for ACHD. The most frequently employed diagnostic modalities were ECG and echocardiography for both mild and moderate/severe CHD. Sixty-seven percent of respondents reported that they routinely address psychosocial well-being. CONCLUSION Differences exist between reported current clinical practice and published guidelines. This is particularly true for the care of patients with mild lesions. In addition, some differences exist between ESC and American guidelines, with more frequent surveillance suggested by the Americans.
Collapse
Affiliation(s)
- Jolien W Roos-Hesselink
- Department of Adult Congenital Cardiology, Erasmus Medical Center, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
| | - Chiara Pelosi
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Margarita Brida
- Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Croatia; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Julie De Backer
- Department of Cardiology and Center for Medical Genetics, Ghent University Hospital, Belgium
| | - Sabine Ernst
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Herestraat 49, Leuven B-3000, Belgium
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, University Health Network, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Giovanni Di Salvo
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; Paediatric Cardiology and CHD, University Hospital of Padua, Italy
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK; Aristotle University Medical School, Thessaloniki, Greece
| | - Gerhard P Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany; School of Cardiovascular Medicine & Sciences, Kings College, London WC2R 2LS, UK
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Minderhoud SCS, Hirsch A, Marin F, Kardys I, Rodríguez-Matas JF, Chiastra C, Roos-Hesselink JW, Wentzel JJ, Helbing WA, Akyildiz AC. Serial RV wall stress measurements: association with right ventricular function in repaired Tetralogy of Fallot patients. Front Cardiovasc Med 2023; 10:1256792. [PMID: 37928767 PMCID: PMC10621746 DOI: 10.3389/fcvm.2023.1256792] [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: 07/11/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
Background Optimal timing of pulmonary valve replacement (PVR) in Tetralogy of Fallot (TOF) patients remains challenging. Ventricular wall stress is considered to be an early marker of right ventricular (RV) dysfunction. Objectives To investigate the association of RV wall stresses and their change over time with functional parameters in TOF patients. Methods Ten TOF patients after surgical repair with moderate/severe pulmonary regurgitation were included. At two timepoints (median follow-up time 7.2 years), patient-specific computational biventricular models for wall stress assessment were created using CMR short-axis cine images and echocardiography-based RV pressures. RV ejection fraction (RVEF), NT-proBNP and cardiopulmonary exercise tests were used as outcome measures reflecting RV function. Associations between regional RV diastolic wall stress and RV function were investigated using linear mixed models. Results Increased wall stress correlated with lower RV mass (rrm = -0.70, p = 0.017) and lower RV mass-to-volume (rrm = -0.80, p = 0.003) using repeated measures. Wall stress decreased significantly over time, especially in patients with a stable RVEF (p < 0.001). Higher wall stress was independently associated with lower RVEF, adjusted for left ventricular ejection fraction, RV end-diastolic volume and time since initial surgery (decrease of 1.27% RVEF per kPa increase in wall stress, p = 0.029) using repeated measurements. No association was found between wall stress, NT-proBNP, and exercise capacity. Conclusions Using a computational method to calculate wall stress locally in geometrically complex ventricles, we demonstrated that lower wall stress might be important to maintain ventricular function. RV wall stress assessment can be used in serial follow-up, and is potentially an early marker of impending RV dysfunction.
Collapse
Affiliation(s)
- Savine C. S. Minderhoud
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Francesca Marin
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - José F. Rodríguez-Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jolanda J. Wentzel
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Willem A. Helbing
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Paediatric Cardiology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ali C. Akyildiz
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| |
Collapse
|
4
|
Aronoff EB, Chin C, Opotowsky AR, Mays WA, Knecht SK, Goessling J, Rice M, Shertzer J, Wittekind SG, Powell AW. Facility-Based and Virtual Cardiac Rehabilitation in Young Patients with Heart Disease During the COVID-19 Era. Pediatr Cardiol 2023:10.1007/s00246-023-03202-0. [PMID: 37294337 DOI: 10.1007/s00246-023-03202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Cardiac rehabilitation (CR) is an important tool for improving fitness and quality of life in those with heart disease (HD). Few pediatric centers use CR to care for these patients, and virtual CR is rarely used. In addition, it is unclear how the COVID-19 era has changed CR outcomes. This study assessed fitness improvements in young HD patients participating in both facility-based and virtual CR during the COVID-19 pandemic. This retrospective single-center cohort study included new patients who completed CR from March 2020 through July 2022. CR outcomes included physical, performance, and psychosocial measures. Comparison between serial testing was performed with a paired t test with P < 0.05 was considered significant. Data are reported as mean ± standard deviation. There were 47 patients (19 ± 7.3 years old; 49% male) who completed CR. Improvements were seen in peak oxygen consumption (VO2, 62.3 ± 16.1 v 71 ± 18.2% of predicted, p = 0.0007), 6-min walk (6 MW) distance (401 ± 163.8 v 480.7 ± 119.2 m, p = < 0.0001), sit to stand (16.2 ± 4.9 v 22.1 ± 6.6 repetitions; p = < 0.0001), Patient Health Questionnaire-9 (PHQ-9) (5.9 ± 4.3 v 4.4 ± 4.2; p = 0.002), and Physical Component Score (39.9 ± 10.1 v 44.9 ± 8.8; p = 0.002). Facility-based CR enrollees were less likely to complete CR than virtual patients (60%, 33/55 v 80%, 12/15; p = 0.005). Increases in peak VO2 (60 ± 15.3 v 70.2 ± 17.8% of predicted; p = 0.002) were seen among those that completed facility-based CR; this was not observed in the virtual group. Both groups demonstrated improvement in 6 MW distance, sit-to-stand repetitions, and sit-and-reach distance. Completion of a CR program resulted in fitness improvements during the COVID-19 era regardless of location, although peak VO2 improved more for the in-person group.
Collapse
Affiliation(s)
- Elizabeth B Aronoff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Clifford Chin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH, 45229-3026, USA
| | - Alexander R Opotowsky
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH, 45229-3026, USA
| | - Wayne A Mays
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH, 45229-3026, USA
| | - Sandra K Knecht
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH, 45229-3026, USA
| | - Jennah Goessling
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH, 45229-3026, USA
| | - Malloree Rice
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH, 45229-3026, USA
| | - Justine Shertzer
- Department of Pediatric Cardiology, The Heart, Vascular, and Thoracic Institute, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Samuel G Wittekind
- Department of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Adam W Powell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH, 45229-3026, USA.
| |
Collapse
|
5
|
Schuermans A, Boerma M, Sansoni GA, Van den Eynde J, Takkenberg JJM, Helbing WA, Geva T, Moons P, Van De Bruaene A, Budts W. Exercise in patients with repaired tetralogy of Fallot: a systematic review and meta-analysis. Heart 2023:heartjnl-2022-321850. [PMID: 36639227 DOI: 10.1136/heartjnl-2022-321850] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Children and adults with repaired tetralogy of Fallot (rTOF) have an impaired exercise capacity, a less active lifestyle and an increased long-term risk of adverse outcomes compared with healthy peers. This study aimed to summarise the current evidence for the effectiveness and safety of exercise training interventions in patients with rTOF. METHODS PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus and reference lists of relevant articles were searched for prospective studies published by November 2021. Random-effects meta-analysis and descriptive synthesis were performed to assess the effectiveness and safety of exercise training in patients with rTOF. RESULTS Of the 9677 citations identified, 12 articles were included that reported on 10 unique studies and covered 208 patients with rTOF (range of mean/median age: 7.4-43.3 years). All studies implemented 2 to 7 aerobic or respiratory training sessions per week with durations ranging from 6 to 26 weeks. Meta-analysis of the included randomised controlled trials showed that exercise training was associated with a significant improvement in peak VO2 (pooled mean difference: +3.1 mL/min/kg; 95% CI: 0.76 to 5.36 mL/min/kg, p=0.019). Cardiac imaging studies revealed no subclinical adverse remodelling after the exercise interventions. No serious adverse events including arrhythmias were reported in these studies. CONCLUSION Current evidence suggests that exercise training can improve exercise capacity in patients with rTOF with a low risk for adverse events. Exercise prescription may be a safe and effective tool to help improving outcomes in patients with rTOF. PROSPERO REGISTRATION NUMBER CRD42021292809.
Collapse
Affiliation(s)
- Art Schuermans
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Flanders, Belgium
| | - Melissa Boerma
- Faculty of Medical Sciences, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Gabriela A Sansoni
- Faculty of Medicine and Surgery, Università degli Studi di Milano, Milan, Italy
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Flanders, Belgium
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Västra Götaland, Sweden
| | - Alexander Van De Bruaene
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Flanders, Belgium.,Congenital and Structural Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Werner Budts
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Flanders, Belgium.,Congenital and Structural Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| |
Collapse
|
6
|
Alipour Symakani RS, van Genuchten WJ, Zandbergen LM, Henry S, Taverne YJHJ, Merkus D, Helbing WA, Bartelds B. The right ventricle in tetralogy of Fallot: adaptation to sequential loading. Front Pediatr 2023; 11:1098248. [PMID: 37009270 PMCID: PMC10061113 DOI: 10.3389/fped.2023.1098248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Right ventricular dysfunction is a major determinant of outcome in patients with complex congenital heart disease, as in tetralogy of Fallot. In these patients, right ventricular dysfunction emerges after initial pressure overload and hypoxemia, which is followed by chronic volume overload due to pulmonary regurgitation after corrective surgery. Myocardial adaptation and the transition to right ventricular failure remain poorly understood. Combining insights from clinical and experimental physiology and myocardial (tissue) data has identified a disease phenotype with important distinctions from other types of heart failure. This phenotype of the right ventricle in tetralogy of Fallot can be described as a syndrome of dysfunctional characteristics affecting both contraction and filling. These characteristics are the end result of several adaptation pathways of the cardiomyocytes, myocardial vasculature and extracellular matrix. As long as the long-term outcome of surgical correction of tetralogy of Fallot remains suboptimal, other treatment strategies need to be explored. Novel insights in failure of adaptation and the role of cardiomyocyte proliferation might provide targets for treatment of the (dysfunctional) right ventricle under stress.
Collapse
Affiliation(s)
- Rahi S. Alipour Symakani
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
- Correspondence: Rahi S. Alipour Symakani
| | - Wouter J. van Genuchten
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Lotte M. Zandbergen
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), University Clinic Munich, Munich, Germany
| | - Surya Henry
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Cell Biology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Daphne Merkus
- Department of Cardiology, Division of Experimental Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Walter Brendel Center of Experimental Medicine (WBex), University Clinic Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), Munich, Germany
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Beatrijs Bartelds
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| |
Collapse
|
7
|
Awosika A, Hillman AR, Millis RM, Adeniyi MJ. Cardiac Rehabilitation and Cardiopulmonary Fitness in Children and Young Adults With Congenital Heart Diseases: A Critically Appraised Topic. Cureus 2022; 14:e31483. [PMID: 36408315 PMCID: PMC9665330 DOI: 10.7759/cureus.31483] [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] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
Public health guidelines and a myriad of studies have proven that exercise is beneficial in the alleviation of various cardio-metabolic diseases. Congenital heart disease (ConHD) is one of the most frequently occurring congenital structural malfunctions in the pediatric population, affecting nine of every 1,000 live births. Only a few studies have established the impact of a structured exercise program on cardiopulmonary fitness in diverse groups of patients with ConHD. It is also alarming to know that a substantial number of these patients and their caregivers often remain very wary of exercise. Anxiety about exercise may increase the risk of developing morbid obesity and other long-term health complications of ConHD. The present review of a critically appraised topic is undertaken to answer the question, “Does structured exercise intervention (cardiac rehabilitation) improve cardiorespiratory fitness in children and young adults with ConHD?” Exercise science and the medical literature were searched for studies that engaged the use of aerobic exercise in patients with different ConHD diagnoses. The search yielded four studies after screening with the inclusion and exclusion criteria, which were further narrowed to three studies after a full-text review. These studies yielded results showing significant increments in peak exercise workload, duration, power output, peak oxygen uptake, or improved tissue oxygenation and muscle strength after an exercise training intervention. It is noteworthy that a group identified as “cyanotic palliated” exhibited the most significant impairment both at baseline and after the exercise intervention. This review provides level 1b medical evidence that a structured exercise program may improve cardiopulmonary fitness in patients with ConHD, which is likely to be beneficial to their overall physical, motor, and psychosocial development. The results of this review may be useful for alleviating the anxiety of patients and their caregivers about participation in structured exercise programs. This review should also motivate future research investigations to develop clinical guidelines for the management of patients with ConHD by adding exercise prescriptions to their daily therapeutic regimens.
Collapse
|
8
|
Anderson CAJ, Suna JM, Keating SE, Cordina R, Tran DL, Ayer J, Coombes JS. Safety and efficacy of exercise training in children and adolescents with congenital heart disease: A systematic review and descriptive analysis. Am Heart J 2022; 253:1-19. [PMID: 35768047 DOI: 10.1016/j.ahj.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/01/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND While exercise training is beneficial in the prevention and management of many chronic diseases, the role of exercise training in children and adolescents with congenital heart disease is less understood. We sought to determine the safety and efficacy of exercise training in children and adolescents with congenital heart disease. METHODS We conducted a systematic search of the following databases: PubMed, CINAHL, EMBASE, Web of Science and SportDiscus. We included randomised controlled trials that incorporated an exercise intervention compared with a non-exercising comparator group and examined safety and efficacy in children and adolescents with congenital heart disease. A descriptive analysis of the included trials was then conducted. RESULTS A total of 9 articles from 6 trials (642 participants with varying conditions and disease severity) were included. Significant variability of study participants and outcomes were observed across the trials. No adverse events linked to the exercise interventions were stated. The articles reported numerous positive changes to clinically relevant fitness measures. Exercise capacity improved with exercise training in 3 of 4 trials in which it was measured. Cardiorespiratory fitness showed improvements in 3 of 4 trials. Neuromuscular fitness increased in 1 of 2 trials. Physiological and metabolic parameters were improved, and negative changes were not observed to several clinically important measures (e.g. muscular oxygenation, cardiac measures) in 2 of 2 trials. Physical activity increased in 1 of 3 trials. No articles reported on changes in measures of body composition. Outcomes are varied with little consensus on measurements or assessment methods. CONCLUSIONS Exercise training appears to be safe and efficacious for improving physical fitness in children and adolescents with congenital heart disease who have been appropriately screened by their medical team. However, the certainty of the evidence for these findings is low to moderate.
Collapse
Affiliation(s)
- Christopher A J Anderson
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Jessica M Suna
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia; Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Shelley E Keating
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia; Heart Research Institute, Sydney, New South Wales, Australia
| | - Derek L Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia; Heart Research Institute, Sydney, New South Wales, Australia
| | - Julian Ayer
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia; The Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jeff S Coombes
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, Benzer W, Metz M, Jensen K, Rauch B, Bönner G, Brzoska P, Buhr-Schinner H, Charrier A, Cordes C, Dörr G, Eichler S, Exner AK, Fromm B, Gielen S, Glatz J, Gohlke H, Grilli M, Gysan D, Härtel U, Hahmann H, Herrmann-Lingen C, Karger G, Karoff M, Kiwus U, Knoglinger E, Krusch CW, Langheim E, Mann J, Max R, Metzendorf MI, Nebel R, Niebauer J, Predel HG, Preßler A, Razum O, Reiss N, Saure D, von Schacky C, Schütt M, Schultz K, Skoda EM, Steube D, Streibelt M, Stüttgen M, Stüttgen M, Teufel M, Tschanz H, Völler H, Vogel H, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10:jcm10143071. [PMID: 34300237 PMCID: PMC8306118 DOI: 10.3390/jcm10143071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
Collapse
Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany
- Correspondence:
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | | | | | - Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany;
- Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany;
| | - Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany;
| | | | | | - Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany;
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | - Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany;
| | - Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | - Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany;
| | - Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany;
| | - Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany;
| | - Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany;
| | | | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany;
| | | | | | | | | | | | - Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | | | - Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany;
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | | | - Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany;
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany;
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany;
| | | | | | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany;
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
| |
Collapse
|
10
|
Gong YQ, Liu XY, Zhi P, Wei LN, Guo FF, Qian JZ, Wang YX, Dong HL. Exercise training in patients with corrected tetralogy of Fallot: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26108. [PMID: 34032753 PMCID: PMC8154459 DOI: 10.1097/md.0000000000026108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The arrival of transcatheter mitral valve therapies has provided feasible and safe alternatives to medical and surgical treatments for mitral regurgitation. The aim of this study is to estimate the relative efficacy and safety of exercise training in patients with corrected tetralogy of Fallot through meta-analysis. METHODS : A systematic search will be performed using PubMed, EMBASE, the Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP to include random controlled trials or nonrandom controlled trials comparing the efficacy and safety of exercise training in corrected tetralogy of Fallot patients. The risk of bias for the included nonrandom controlled studies will be evaluated according to Risk of Bias in Nonrandomized Studies of Interventions. We will use the Cochrane Collaboration's tool (version 2 of the Cochrane risk of bias tool for randomized trials) to assess risk of bias of included random controlled trials. Revman 5.4 and STATA 15.0 will be used to complete the meta-analysis and generate forest plots. Grading of recommendations assessment, development, and evaluation will be used to assess the quality of evidence. RESULTS : The results of this systematic review and meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION : This study will provide broad evidence of efficacy and safety of exercise training in patients with corrected tetralogy of Fallot and provide suggestions for clinical practice and future research. PROTOCOL REGISTRATION NUMBER INPLASY202150006.
Collapse
Affiliation(s)
- Ya-Qin Gong
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Xiao-Yan Liu
- Department of Thoracic Surgery, The First Hospital of Longnan City, Longnan, China
| | - Ping Zhi
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Li-Na Wei
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Fang-Fei Guo
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Jin-Zhi Qian
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Yun-Xia Wang
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - He-Li Dong
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| |
Collapse
|
11
|
Tran DL, Maiorana A, Davis GM, Celermajer DS, d'Udekem Y, Cordina R. Exercise Testing and Training in Adults With Congenital Heart Disease: A Surgical Perspective. Ann Thorac Surg 2020; 112:1045-1054. [PMID: 33285131 DOI: 10.1016/j.athoracsur.2020.08.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/16/2020] [Accepted: 08/31/2020] [Indexed: 01/18/2023]
Abstract
In the current era, the majority of children born with congenital heart disease (CHD) will survive well into adulthood because of major advances in surgical techniques, as well as in critical and medical care. However, reoperation and palliative surgical interventions are increasingly common in the adults with CHD. Tools to risk stratify patients effectively and therapies to improve outcomes are required to optimize the management of adult patients with CHD during the preoperative and postoperative periods and beyond. Exercise testing is an invaluable tool to guide risk stratification. In addition, exercise training in patients with CHD may decrease postoperative complications by enhancing physiological reserve and also has an important role in physical rehabilitation. This review aims to provide individualized recommendations on exercise prescription in patients with CHD in the preoperative and postoperative settings. The response to exercise testing and prognostic implications is also discussed.
Collapse
Affiliation(s)
- Derek L Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia; Discipline of Exercise and Sport Science, University of Sydney, Camperdown, Australia; Heart Research Institute, Newtown, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia; Allied Health Department, Fiona Stanley Hospital, Murdoch, Australia
| | - Glen M Davis
- Discipline of Exercise and Sport Science, University of Sydney, Camperdown, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia; Heart Research Institute, Newtown, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Parkville, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Parkville, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia; Heart Research Institute, Newtown, Australia; Murdoch Children's Research Institute, Parkville, Australia.
| |
Collapse
|
12
|
Physical Activity Promotion in Pediatric Congenital Heart Disease: Are We Running Late? Can J Cardiol 2020; 36:1406-1416. [DOI: 10.1016/j.cjca.2020.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
|
13
|
Mishra S, Sharma R. Proposed method for evaluation and categorization of functional capacity of children, adolescents, and adults with cardiac diseases to bring them in existing social justice system by creating the cardiac disability criteria. Indian J Thorac Cardiovasc Surg 2020; 36:207-225. [PMID: 33061127 PMCID: PMC7525653 DOI: 10.1007/s12055-019-00895-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 08/20/2019] [Accepted: 09/01/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Emerging epidemiological trends in India indicate the rising burden of cardiovascular diseases (CVDs) demanding a need of a social support system. Yet, the list of 21 benchmark disabilities notified by the Department of Empowerment of Persons with Disabilities, Ministry of Social Justice and Empowerment, Government of India, does not include CVDs under the newly enacted Rights of Persons with Disabilities (RPWD) Act, 2016. While the RPWD Act 2016 has acknowledged the dynamic nature of disabilities associated with congenital diseases like thalassemia, it has also provided an opportunity to bring in "cardiac disability" under its tenets. This would allow India to adopt strategies for the benefit of cardiac patients in accordance with policies adopted by developed countries such as the United States of America (USA), the United Kingdom of Great Britain (UK), and Canada. This document is to initiate a thought process of recruitment of cardiac patients in the social justice system. AIMS AND OBJECTIVES (1) To define cardiac disability, (2) to categorize cardiac diseases/defects (groups A-C) according to severity and need for interventions, (3) to identify operated and unoperated patients with normal functional capacity and their eligibility to avail normal opportunities similar to their peer groups, (4) to create a comprehensive cardiac disability scoring (CCDS) system for disability certification based on subjective and objective evaluation of functional capacity and the corresponding heart disease category group, and (5) to create a reference literature for the issues of education, employability, insurability, and vocational counseling based on this document. METHODOLOGY The evolution of this manuscript has been discussed in view of relevant observations made by a team of cardiologists, cardiac surgeons, intensivists, pediatricians, social workers, etc. CONCLUSION This manuscript suggests a CCDS system to lay down criteria for disability status for eligible patients suffering from cardiovascular diseases. It intends to offer a unique scientific tool to address the psychosocial and socio-economic bias against patients with heart diseases of heterogeneous nature.
Collapse
Affiliation(s)
- Smita Mishra
- Department of Pediatric Cardiology, Manipal Hospital, Dwarka Sector 6, Delhi, India
| | - Rajesh Sharma
- Paediatric Cardiac Surgery, Jaypee Hospital, Sector 128, Noida, UP India
| |
Collapse
|
14
|
Recommendations for exercise in adolescents and adults with congenital heart disease. Prog Cardiovasc Dis 2020; 63:350-366. [DOI: 10.1016/j.pcad.2020.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 12/17/2022]
|
15
|
Amedro P, Gavotto A, Legendre A, Lavastre K, Bredy C, De La Villeon G, Matecki S, Vandenberghe D, Ladeveze M, Bajolle F, Bosser G, Bouvaist H, Brosset P, Cohen L, Cohen S, Corone S, Dauphin C, Dulac Y, Hascoet S, Iriart X, Ladouceur M, Mace L, Neagu OA, Ovaert C, Picot MC, Poirette L, Sidney F, Soullier C, Thambo JB, Combes N, Bonnet D, Guillaumont S. Impact of a centre and home-based cardiac rehabilitation program on the quality of life of teenagers and young adults with congenital heart disease: The QUALI-REHAB study rationale, design and methods. Int J Cardiol 2019; 283:112-118. [DOI: 10.1016/j.ijcard.2018.12.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/11/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022]
|
16
|
Abstract
This commentary highlights 23 noteworthy publications from 2018, selected by leading scientists in pediatric exercise science. These publications have been deemed as significant or exciting in the field as they (a) reveal a new mechanism, (b) highlight a new measurement tool, (c) discuss a new concept or interpretation/application of an existing concept, or (d) describe a new therapeutic approach or clinical tool in youth. In some cases, findings in adults are highlighted, as they may have important implications in youth. The selected publications span the field of pediatric exercise science, specifically focusing on: aerobic exercise and training; neuromuscular physiology, exercise, and training; endocrinology and exercise; resistance training; physical activity and bone strength; growth, maturation, and exercise; physical activity and cognition; childhood obesity, physical activity, and exercise; pulmonary physiology or diseases, exercise, and training; immunology and exercise; cardiovascular physiology and disease; and physical activity, inactivity, and health.
Collapse
|
17
|
Habert P, Bentatou Z, Aldebert P, Finas M, Bartoli A, Bal L, Lalande A, Rapacchi S, Guye M, Kober F, Bernard M, Jacquier A. Exercise stress CMR reveals reduced aortic distensibility and impaired right-ventricular adaptation to exercise in patients with repaired tetralogy of Fallot. PLoS One 2018; 13:e0208749. [PMID: 30596647 PMCID: PMC6312273 DOI: 10.1371/journal.pone.0208749] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of our study was to evaluate the feasibility of exercise cardiac magnetic resonance (CMR) in patients with repaired tetralogy of Fallot (RTOF) and to assess right and left ventricular adaptation and aortic wall response to exercise in comparison with volunteers. METHODS 11 RTOF and 11 volunteers underwent prospective CMR at rest and during exercise. A supine bicycle ergometer was employed to reach twice the resting heart rate during continuous exercise, blood pressure and heart rate were recorded. Bi-ventricular parameters and aortic stiffness were assessed using accelerated cine sequences and flow-encoding CMR. A t-test was used to compare values between groups. A Mann Whitney test was used to compare values within groups. RESULTS In RTOF both ventricles showed an impaired contractile reserve (RVEF rest 36.2±8.3%, +1.3±3.9% increase after exercise; LVEF rest 53.8±6.1%, +5.7±6.4% increase after exercise) compared to volunteers (RVEF rest 50.5±5.0%, +10.4±7.1% increase after exercise, p = 0.039; LVEF rest 61.9±3.1%, +12.2±4.7% increase after exercise, p = 0.014). RTOF showed a reduced distensibility of the ascending aorta during exercise compared to volunteers (RTOF: 3.4±1.9 10-3.mmHg-1 vs volunteers: 5.1±1.4 10-3.mmHg-1; p = 0.027). Ascending aorta distensibility was correlated to cardiac work in the volunteers but not in RTOF. CONCLUSION RTOF showed an impaired contractile reserve for both ventricles. The exercise unmasked a reduced distensibility of the ascending aorta in RTOF, which may be an early sign of increased aortic rigidity.
Collapse
Affiliation(s)
- Paul Habert
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
- * E-mail:
| | | | - Philippe Aldebert
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Cardiology and Department of Infectious Diseases, La Timone Hospital, Marseille, France
| | | | - Axel Bartoli
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
| | - Laurence Bal
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Vascular Surgery and Vascular Medicine, La Timone Hospital, Marseille, France
| | - Alain Lalande
- LE2I, UMR 6306 CNRS, University of Burgundy, Dijon, France
- MRI Department, University Hospital of Dijon, Dijon, France
| | | | - Maxime Guye
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Frank Kober
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | | | - Alexis Jacquier
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
| |
Collapse
|
18
|
Di Salvo G, Miller O, Babu Narayan S, Li W, Budts W, Valsangiacomo Buechel ER, Frigiola A, van den Bosch AE, Bonello B, Mertens L, Hussain T, Parish V, Habib G, Edvardsen T, Geva T, Baumgartner H, Gatzoulis MA, Delgado V, Haugaa KH, Lancellotti P, Flachskampf F, Cardim N, Gerber B, Masci PG, Donal E, Gimelli A, Muraru D, Cosyns B. Imaging the adult with congenital heart disease: a multimodality imaging approach—position paper from the EACVI. Eur Heart J Cardiovasc Imaging 2018; 19:1077-1098. [DOI: 10.1093/ehjci/jey102] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Giovanni Di Salvo
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Sonya Babu Narayan
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Wei Li
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | - Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Leuven, Belgium
| | | | - Alessandra Frigiola
- Adult Congenital Heart Disease, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, UK
| | | | - Beatrice Bonello
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, SickKids, 555 University Avenue Toronto, Ontario, Canada
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | | | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Boulevard Jean Moulin, Marseille, France
| | - Thor Edvardsen
- Department of Cardiology, Sognsvannsveien 20, Oslo, Norvegia
| | - Tal Geva
- Department of Cardiology, 300 Longwood Avenue, Farley, Boston, Massachusetts, USA
| | | | - Michael A Gatzoulis
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Novaković M, Prokšelj K, Rajkovič U, Vižintin Cuderman T, Janša Trontelj K, Fras Z, Jug B. Exercise training in adults with repaired tetralogy of Fallot: A randomized controlled pilot study of continuous versus interval training. Int J Cardiol 2018; 255:37-44. [DOI: 10.1016/j.ijcard.2017.12.105] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/28/2017] [Accepted: 12/27/2017] [Indexed: 01/28/2023]
|
20
|
Sandberg C, Hedström M, Wadell K, Dellborg M, Ahnfelt A, Zetterström AK, Öhrn A, Johansson B. Home-based interval training increases endurance capacity in adults with complex congenital heart disease. CONGENIT HEART DIS 2017; 13:254-262. [DOI: 10.1111/chd.12562] [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: 01/03/2017] [Revised: 08/21/2017] [Accepted: 10/19/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Camilla Sandberg
- Heart Center and Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy; Umeå University; Umeå Sweden
| | - Magnus Hedström
- Heart Center and Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Physiotherapy; Umeå University; Umeå Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - Anders Ahnfelt
- Department of Molecular and Clinical Medicine; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - Anna-Klara Zetterström
- Department of Physiotherapy and Occupational Therapy; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Amanda Öhrn
- Department of Physiotherapy and Occupational Therapy; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Bengt Johansson
- Heart Center and Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| |
Collapse
|
21
|
Ávila P, Marcotte F, Dore A, Mercier LA, Shohoudi A, Mongeon FP, Mondésert B, Proietti A, Ibrahim R, Asgar A, Poirier N, Khairy P. The impact of exercise on ventricular arrhythmias in adults with tetralogy of Fallot. Int J Cardiol 2016; 219:218-24. [DOI: 10.1016/j.ijcard.2016.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/12/2016] [Indexed: 12/19/2022]
|
22
|
Budts W, Roos-Hesselink J, Rädle-Hurst T, Eicken A, McDonagh TA, Lambrinou E, Crespo-Leiro MG, Walker F, Frogoudaki AA. Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2016; 37:1419-27. [PMID: 26787434 DOI: 10.1093/eurheartj/ehv741] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022] Open
Affiliation(s)
- Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja Rädle-Hurst
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | | | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences Cyprus University of Technology, Limassol, Cyprus
| | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Service, Hospital Universitario A Coruña, La Coruña, Spain
| | - Fiona Walker
- Centre for Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
| | - Alexandra A Frogoudaki
- Adult Congenital Heart Clinic, Second Cardiology Department, ATTIKON University Hospital and Athens University, Athens, Greece
| |
Collapse
|
23
|
Molossi S, Grenier M. The Management of Athletes with Congenital Heart Disease. Clin Sports Med 2015; 34:551-70. [DOI: 10.1016/j.csm.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|