Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testing
Aim: The aim of the study was to compare functional capacity in different types of congenital heart disease (CHD), as assessed by cardiopulmonary exercise testing (CPET). Methods: A retrospective analysis was performed of adult patients with CHD who had undergone CPET in a single tertiary center. Di...
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Elsevier
2018-05-01
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Series: | Revista Portuguesa de Cardiologia |
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DOAJ |
language |
English |
format |
Article |
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DOAJ |
author |
Sílvia Aguiar Rosa Ana Agapito Rui M. Soares Lídia Sousa José Alberto Oliveira Ana Abreu Ana Sofia Silva Sandra Alves Helena Aidos Fátima F. Pinto Rui Cruz Ferreira |
spellingShingle |
Sílvia Aguiar Rosa Ana Agapito Rui M. Soares Lídia Sousa José Alberto Oliveira Ana Abreu Ana Sofia Silva Sandra Alves Helena Aidos Fátima F. Pinto Rui Cruz Ferreira Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testing Revista Portuguesa de Cardiologia |
author_facet |
Sílvia Aguiar Rosa Ana Agapito Rui M. Soares Lídia Sousa José Alberto Oliveira Ana Abreu Ana Sofia Silva Sandra Alves Helena Aidos Fátima F. Pinto Rui Cruz Ferreira |
author_sort |
Sílvia Aguiar Rosa |
title |
Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testing |
title_short |
Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testing |
title_full |
Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testing |
title_fullStr |
Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testing |
title_full_unstemmed |
Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testing |
title_sort |
congenital heart disease in adults: assessmentof functional capacity using cardiopulmonary exercise testing |
publisher |
Elsevier |
series |
Revista Portuguesa de Cardiologia |
issn |
0870-2551 |
publishDate |
2018-05-01 |
description |
Aim: The aim of the study was to compare functional capacity in different types of congenital heart disease (CHD), as assessed by cardiopulmonary exercise testing (CPET). Methods: A retrospective analysis was performed of adult patients with CHD who had undergone CPET in a single tertiary center. Diagnoses were divided into repaired tetralogy of Fallot, transposition of the great arteries (TGA) after Senning or Mustard procedures or congenitally corrected TGA, complex defects, shunts, left heart valve disease and right ventricular outflow tract obstruction. Results: We analyzed 154 CPET cases. There were significant differences between groups, with the lowest peak oxygen consumption (VO2) values seen in patients with cardiac shunts (39% with Eisenmenger physiology) (17.2±7.1 ml/kg/min, compared to 26.2±7.0 ml/kg/min in tetralogy of Fallot patients; p<0.001), the lowest percentage of predicted peak VO2 in complex heart defects (50.1±13.0%) and the highest minute ventilation/carbon dioxide production slope in cardiac shunts (38.4±13.4). Chronotropism was impaired in patients with complex defects. Eisenmenger syndrome (n=17) was associated with the lowest peak VO2 (16.9±4.8 vs. 23.6±7.8 ml/kg/min; p=0.001) and the highest minute ventilation/carbon dioxide production slope (44.8±14.7 vs. 31.0± 8.5; p=0.002). Age, cyanosis, CPET duration, peak systolic blood pressure, time to anaerobic threshold and heart rate at anaerobic threshold were predictors of the combined outcome of all-cause mortality and hospitalization for cardiac cause. Conclusion: Across the spectrum of CHD, cardiac shunts (particularly in those with Eisenmenger syndrome) and complex defects were associated with lower functional capacity and attenuated chronotropic response to exercise. Resumo: Objetivo: Comparar a capacidade funcional nas cardiopatias congénitas, avaliada por prova de esforço cardiorrespiratória. Métodos: Análise restrospetiva dos doentes adultos com cardiopatia congénita, submetidos a prova de esforço cardiorrespiratória. Os doentes foram divididos em tetralogia de Fallot operada, transposição de grandes artérias após cirurgia de Senning/Mustard, transposição de grandes artérias congenitamente corrigida, defeitos complexos, shunts, doença valvular esquerda e obstrução do trato de saída do ventrículo direito. Resultados: Foram avaliadas 154 provas cardiorrespiratórias. Os valores mais baixos de consumo de oxigénio no pico foram observados nos doentes com shunt cardíaco (39% apresentavam síndrome de Eisenmenger) (17,2 ± 7,1 ml/kg/min, em comparação com 26,2 ± 7,0 ml/kg/min na tetralogia de Fallot; p < 0,001); o valor mais baixo da percentagem de consumo de oxigénio no pico relativamente ao previsto foi observado nos defeitos complexos (50,1 ± 13,0%) e o maior valor de rampa ventilação minuto/produção de dióxido de carbono nos shunts cardíacos (38,4 ± 13,4). O cronotropismo foi menos eficaz nos doentes com defeitos complexos. A síndrome de Eisenmenger (n = 17) associou-se ao valor mais baixo de consumo de oxigénio no pico (16,9 ± 4,8 versus 23,6 ± 7,8 ml/kg/min; p = 0,001) e ao maior valor de rampa ventilação minuto/produção de dióxido de carbono (44,8 ± 14,7 versus 31,0 ± 8,5; p = 0,002). Idade, cianose, duração da prova, pressão arterial sistólica no pico, tempo para o limiar anaeróbio e frequência cardíaca no limiar anaeróbio foram preditores do outcome combinado com mortalidade de todas as causas e hospitalização de causa cardíaca. Conclusão: Os shunts cardíacos (particularmente com síndrome de Eisenmenger) e os defeitos complexos associaram-se a menor capacidade funcional e resposta cronotrópica atenuada ao exercício. Keywords: Adult congenital heart disease, Functional capacity, Cardiopulmonary exercise testing, Palavras-chave: Cardiopatias congénitas do adulto, Capacidade funcional, Prova de esforço cardiorrespiratória |
url |
http://www.sciencedirect.com/science/article/pii/S0870255117300562 |
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doaj-25f2a7bb7021468f8443264968dff59d2020-11-25T02:19:43ZengElsevierRevista Portuguesa de Cardiologia0870-25512018-05-01375399405Congenital heart disease in adults: Assessmentof functional capacity using cardiopulmonary exercise testingSílvia Aguiar Rosa0Ana Agapito1Rui M. Soares2Lídia Sousa3José Alberto Oliveira4Ana Abreu5Ana Sofia Silva6Sandra Alves7Helena Aidos8Fátima F. Pinto9Rui Cruz Ferreira10Cardiology Department, Santa Marta Hospital, Lisbon, Portugal; Corresponding author.Cardiology Department, Santa Marta Hospital, Lisbon, PortugalCardiology Department, Santa Marta Hospital, Lisbon, PortugalCardiology Department, Santa Marta Hospital, Lisbon, PortugalCardiology Department, Santa Marta Hospital, Lisbon, PortugalCardiology Department, Santa Marta Hospital, Lisbon, PortugalCardiology Department, Santa Marta Hospital, Lisbon, PortugalCardiology Department, Santa Marta Hospital, Lisbon, PortugalInstituto de Telecomunicações, Instituto Superior Técnico, Portugal Minalytics, Advanced Solutions for Data Mining and Analytics, Lisbon, PortugalPaediatric Cardiology Department, Santa Marta Hospital, Lisbon, PortugalCardiology Department, Santa Marta Hospital, Lisbon, PortugalAim: The aim of the study was to compare functional capacity in different types of congenital heart disease (CHD), as assessed by cardiopulmonary exercise testing (CPET). Methods: A retrospective analysis was performed of adult patients with CHD who had undergone CPET in a single tertiary center. Diagnoses were divided into repaired tetralogy of Fallot, transposition of the great arteries (TGA) after Senning or Mustard procedures or congenitally corrected TGA, complex defects, shunts, left heart valve disease and right ventricular outflow tract obstruction. Results: We analyzed 154 CPET cases. There were significant differences between groups, with the lowest peak oxygen consumption (VO2) values seen in patients with cardiac shunts (39% with Eisenmenger physiology) (17.2±7.1 ml/kg/min, compared to 26.2±7.0 ml/kg/min in tetralogy of Fallot patients; p<0.001), the lowest percentage of predicted peak VO2 in complex heart defects (50.1±13.0%) and the highest minute ventilation/carbon dioxide production slope in cardiac shunts (38.4±13.4). Chronotropism was impaired in patients with complex defects. Eisenmenger syndrome (n=17) was associated with the lowest peak VO2 (16.9±4.8 vs. 23.6±7.8 ml/kg/min; p=0.001) and the highest minute ventilation/carbon dioxide production slope (44.8±14.7 vs. 31.0± 8.5; p=0.002). Age, cyanosis, CPET duration, peak systolic blood pressure, time to anaerobic threshold and heart rate at anaerobic threshold were predictors of the combined outcome of all-cause mortality and hospitalization for cardiac cause. Conclusion: Across the spectrum of CHD, cardiac shunts (particularly in those with Eisenmenger syndrome) and complex defects were associated with lower functional capacity and attenuated chronotropic response to exercise. Resumo: Objetivo: Comparar a capacidade funcional nas cardiopatias congénitas, avaliada por prova de esforço cardiorrespiratória. Métodos: Análise restrospetiva dos doentes adultos com cardiopatia congénita, submetidos a prova de esforço cardiorrespiratória. Os doentes foram divididos em tetralogia de Fallot operada, transposição de grandes artérias após cirurgia de Senning/Mustard, transposição de grandes artérias congenitamente corrigida, defeitos complexos, shunts, doença valvular esquerda e obstrução do trato de saída do ventrículo direito. Resultados: Foram avaliadas 154 provas cardiorrespiratórias. Os valores mais baixos de consumo de oxigénio no pico foram observados nos doentes com shunt cardíaco (39% apresentavam síndrome de Eisenmenger) (17,2 ± 7,1 ml/kg/min, em comparação com 26,2 ± 7,0 ml/kg/min na tetralogia de Fallot; p < 0,001); o valor mais baixo da percentagem de consumo de oxigénio no pico relativamente ao previsto foi observado nos defeitos complexos (50,1 ± 13,0%) e o maior valor de rampa ventilação minuto/produção de dióxido de carbono nos shunts cardíacos (38,4 ± 13,4). O cronotropismo foi menos eficaz nos doentes com defeitos complexos. A síndrome de Eisenmenger (n = 17) associou-se ao valor mais baixo de consumo de oxigénio no pico (16,9 ± 4,8 versus 23,6 ± 7,8 ml/kg/min; p = 0,001) e ao maior valor de rampa ventilação minuto/produção de dióxido de carbono (44,8 ± 14,7 versus 31,0 ± 8,5; p = 0,002). Idade, cianose, duração da prova, pressão arterial sistólica no pico, tempo para o limiar anaeróbio e frequência cardíaca no limiar anaeróbio foram preditores do outcome combinado com mortalidade de todas as causas e hospitalização de causa cardíaca. Conclusão: Os shunts cardíacos (particularmente com síndrome de Eisenmenger) e os defeitos complexos associaram-se a menor capacidade funcional e resposta cronotrópica atenuada ao exercício. Keywords: Adult congenital heart disease, Functional capacity, Cardiopulmonary exercise testing, Palavras-chave: Cardiopatias congénitas do adulto, Capacidade funcional, Prova de esforço cardiorrespiratóriahttp://www.sciencedirect.com/science/article/pii/S0870255117300562 |