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Aerobic capacity in adults with various congenital heart diseases
P M Fredriksen1, G Veldtman, S Hechter
1University Health Network, University of Toronto Cardiac Centre for Adults, Ontario, Canada.
Insights
Adults with congenital heart disease have reduced aerobic capacity. Maximal oxygen uptake declines with age in most groups, highlighting the need for exercise monitoring in these patients.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Exercise Physiology
Background:
- Growing population of adults with congenital heart disease (CHD) necessitates understanding long-term outcomes.
- Exercise testing is crucial for detecting early signs of impaired cardiac function in adults with CHD.
- Limited data exists on maximal oxygen uptake (VO2 max) reference values for diverse adult CHD populations.
Purpose of the Study:
- To establish mean maximal oxygen uptake (VO2 max) values in adults across various congenital heart disease diagnoses.
- To compare VO2 max in adult CHD patients with healthy individuals and assess age-related changes.
- To provide reference data for clinical assessment and future research in adult CHD.
Main Methods:
- Retrospective analysis of adult patients from six major CHD diagnostic groups: atrial septal defect (ASD), Mustard procedure, congenitally corrected transposition of the great arteries (CCTGA), Tetralogy of Fallot, Ebstein's anomaly, and Modified Fontan procedure.
- Maximal oxygen uptake (VO2 max) and heart rate were measured during exercise testing.
- Forced vital capacity (FVC) was assessed and compared to predicted values.
Main Results:
- All CHD diagnostic groups exhibited diminished maximal oxygen uptake (VO2 max) compared to healthy subjects.
- VO2 max significantly decreased with age in patients with ASD, CCTGA, and Tetralogy of Fallot.
- Patients consistently achieved lower heart rates than predicted; FVC was generally lower than predicted but within acceptable variance for most groups.
Conclusions:
- Adults with various forms of congenital heart disease demonstrate reduced aerobic capacity.
- Age-related decline in VO2 max is evident in specific CHD populations, underscoring the importance of regular monitoring.
- Established VO2 max values serve as valuable references for clinical practice and future research in adult CHD outcomes.
Abstract:
As an increasing number of patients with congenital heart disease reach adulthood, more information is needed regarding outcomes. The first signs of impaired heart function may appear during exercise testing. The aim of the present study was to establish mean values for maximal oxygen uptake in adults with various congenital heart diseases. Patients from 6 major diagnostic groups were identified, including patients with atrial septal defect (ASD, n = 93), transposition of the great arteries corrected with the Mustard procedure (n = 84), congenitally corrected transposition of the great arteries (CCTGA, n = 41), Tetralogy of Fallot (n = 168), Ebstein's anomaly (n = 37), and Modified Fontan procedure (n = 52). Diminished maximal oxygen uptake was found in all diagnostic groups across age compared with healthy subjects. A significant decrease in maximal oxygen uptake with aging was found in those with ASD (p <0.0001), CCTGA (p = 0.01), and Tetralogy of Fallot (p <0.0001). There was no significant decline, however, in Ebstein's anomaly (p = 0.270), Fontan procedure (p = 0.182), and in the Mustard patients (p = 0.188). All patients achieved significantly lower heart rates than predicted (mean for all groups, p <0.0001). Forced vital capacity values (3.51 L, mean SD +/- 1.02) were lower than predicted values (4.10 L, mean SD +/- 0.90, p <0.0001) for all patients groups except those with ASD. Mean values, however, were within the accepted 20% range of variance. This study showed diminished aerobic capacity in all diagnostic groups when compared with a healthy population. The maximal oxygen uptake values across age groups can be used as reference values in patients with similar diagnoses and as the basis for further research.