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A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Exercise capacity following pediatric heart transplantation: A systematic review
Sara Peterson1,2, Jennifer A Su3, Jacqueline R Szmuszkovicz3
1Division of Pediatric Rehabilitation Medicine, Physical Therapy, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Pediatric heart transplant (HT) recipients show reduced exercise capacity compared to controls. Factors like chronotropic incompetence and deconditioning contribute to this impairment, impacting their physical function long-term.
Area of Science:
- Cardiology
- Pediatric Medicine
- Exercise Physiology
Background:
- Pediatric heart transplantation (HT) represents 13% of all HTs, with over 60% of recipients surviving beyond 10 years.
- Understanding the exercise capacity of these young survivors is crucial for their long-term health and rehabilitation.
Purpose of the Study:
- To systematically review and synthesize existing literature on the exercise capacity of pediatric heart transplant recipients.
- To identify and understand the physiological mechanisms underlying reduced exercise capacity in this population.
Main Methods:
- A systematic literature search was conducted across six databases.
- Studies comparing exercise capacity in heart transplant recipients aged ≤21 years with control groups or normative data were included.
- Sixteen studies met the inclusion criteria for analysis.
Main Results:
- Pediatric HT recipients demonstrated significantly higher resting heart rates (HR) compared to controls.
- At peak exercise, recipients exhibited significantly decreased HR, VO2, power, work, minute ventilation, and exercise duration.
- While peak VO2 improved within 2.5 years post-HT, peak work remained constant, with inconclusive evidence for improvements in peak HR, HR recovery, or HR reserve over time.
Conclusions:
- Pediatric heart transplant recipients experience impaired exercise capacity, characterized by reduced peak aerobic and anaerobic function.
- Potential contributing mechanisms include chronotropic incompetence, graft dysfunction, immunosuppression side effects, and deconditioning.
- Further research into effective rehabilitation strategies for pediatric HT survivors is warranted.
Abstract:
Pediatric HTs account for 13% of all HTs with >60% of recipients surviving at least 10 years post-HT. The purpose of this systematic review is to synthesize the literature on exercise capacity of pediatric HT recipients to improve understanding of the mechanisms that may explain the decreased exercise capacity. Six databases were searched for studies that compared the exercise capacity of HT recipients ≤21 years old with a control group or normative data. Sixteen studies were included. Pediatric HT recipients, as compared to controls or normative data, exhibit significantly higher resting HR, and at peak exercise exhibit significantly decreased HR, VO2 , power, work, minute ventilation, and exercise duration. Peak VO2 appears to improve within the first 2.5 years post-HT; peak work remains constant; and there is inconclusive evidence that peak HR, HR recovery, and HR reserve improve with time since HT. These results are discussed in the context of the mechanisms that may explain the impaired exercise capacity of pediatric HT recipients, including chronotropic incompetence, graft dysfunction, side effects of immunosuppression therapy, and deconditioning. In addition, the limited literature on rehabilitation after pediatric HT is summarized.
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